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Topical Treatments for Atopic Dermatitis

You may have heard about some of the medications that are available to treat atopic dermatitis, but may be wondering what makes them all different? This article will help to explain some of the topical treatments available to treat atopic dermatitis, how they work and how patients respond to them.

What are topical treatments?

Topical treatments work from the outside of your body. These are ointments, creams or lotions that are applied to the skin to help relieve symptoms of or to treat atopic dermatitis. Topical treatments are usually only used when you are experiencing active symptoms of atopic dermatitis.

What are some topical treatments for AD?

Topical treatments for atopic dermatitis vary greatly, from over the counter moisturizers to ointments and creams that work by blocking parts of the immune system. The most common topical treatments are:

Moisturizers

Moisturizers such as white petrolatum and Aquaphor can be applied to wet skin after a bath to help maintain moisture by allowing water to be absorbed into the skin.1

Topical corticosteroids

Topical corticosteroids come in many forms, potencies, and strengths. These medications work by relieving inflammation, which can lead to redness and itching, allowing the skin to heal.2 While most corticosteroid medications are available as prescription-only medications, the mildest one, hydrocortisone, is available as an over the counter medication. Corticosteroids are available in creams, ointments, lotions, solutions, gels, and shampoos. They can be used alone, or in combination with other forms of treatment, but only as prescribed by your physician. Overuse of corticosteroids can increase the risk of side effects. Corticosteroids should not be used if you do not have active atopic dermatitis inflammation. These medications have limited short-term side effects but can have some long-term effects.1,2

Calcineurin inhibitors

These medications work by stopping parts of your immune system from releasing proteins that cause the inflammation that leads to atopic dermatitis.1 These medications come in ointment and cream forms and can be used in children as young as two years old.2 They do not have many of the side effects that steroids do but can lead to some light sensitivity.1,2 These medications tend to be much more expensive than corticosteroids and are usually used as second-line therapies.1

PDE4 inhibitors

Currently, there is only one PDE4 inhibitor available to treat atopic dermatitis. This medication also works by blocking an enzyme in your body that can stimulate proteins that cause inflammation.3 This medication is available in an ointment form and can be used in children as young as two years old.

How do people respond to them?

Most patients respond well to topical treatments. While none of these medications prevents atopic dermatitis, they all can treat atopic dermatitis to some degree. All of these medications have some side effects as well.

Topical corticosteroids

Topical corticosteroids are often the first treatment that a patient with atopic dermatitis will receive. While effective, they should only be used during active flares, as they can have some long-term side effects. These include skin thinning or thickening, skin discoloration, and stretch marks.2 While these side effects are not usually permanent, they can be more severe depending on where the medication is used (such as the facial areas).2

Calcineurin inhibitors

Calcineurin inhibitors are effective for many patients, but many patients complain of a stinging sensation when they apply these medications.2 Some patients who have used these medications have had secondary malignancies such as skin cancers and lymphoma. The United States Food and Drug Administration has issued a black box warning that these drugs can an increase in malignancy.1 As such, these medications should always be used as a second line of therapy, and should not be used along with phototherapy for atopic dermatitis.2

PDE4 inhibitors

PDE4 inhibitors have excellent response, with most patients achieving clear to almost clear skin within four weeks of treatment.1,2 The most common side effect is skin irritation where the medication is applied or sensitivity to the active ingredient of the medication.1

Written by Cara King | Reviewed October 2019
  1. Atopic Dermatitis Treatment & Management: Medical Care, Consultations, Diet. Emedicine.medscape.com. https://emedicine.medscape.com/article/1049085- treatment. Published 2019. Accessed April 7, 2019.
  2. What are Topical Treatments for Eczema and How Should They Be Used?. National Eczema Association. https://nationaleczema.org/eczema/treatment/topicals/. Published 2019. Accessed April 7, 2019.
  3. Guttman‐Yassky, E,  Hanifin, JM,  Boguniewicz, M, et al.  The role of phosphodiesterase 4 in the pathophysiology of atopic dermatitis and the perspective for its inhibition. Exp Dermatol.  2019; 28: 3- 10. https://doi.org/10.1111/exd.13808