Medications for Atopic Dermatitis

Since atopic dermatitis—dry, scaly, itchy patches of skin also known as eczema—is a rash that can come and go, different medications are often prescribed for various stages of the condition. Since the skin affected by the disease is considered to be "leaky," the goal of treatment is to make that skin become a better barrier. Let's take a look at the following medications that may be prescribed to help manage the condition.

Three pills and some cream sitting on a table
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Topical Steroids

Topical steroids are steroids that you rub onto the skin, such as creams, as opposed to those that you take in pill form by mouth. They are still the first-line treatment for atopic dermatitis flare-ups because they are effective at reducing the inflammation of the skin. Topical steroids come in seven different strengths, and it is important to use the correct strength corresponding to the severity and location of the rash.

High-strength topical steroids are typically reserved for use on the arms and legs. Eczema that is on the face and skin folds, like armpits or groin, on the other hand, can usually be treated with low-strength steroids. Sometimes, a doctor might recommend taking a potent steroid for a limited time for faster relief and then moving to a milder steroid.

It is common for doctors to prescribe more than one corticosteroid strength at the same time. Sometimes, a lower strength topical steroid will be prescribed for use on certain body parts and/or on rashes with milder severity, and a stronger steroid will be prescribed for use on other body parts and/or worse affected regions.

Hydrocortisone 1% cream is a low strength topical corticosteroid that is available over the counter and can be effective in treating very mild atopic dermatitis. If treatment is needed for more than a week, additional treatment is likely necessary and seeking physician care is prudent.

Calcineurin Inhibitors

The calcineurin inhibitors are Protopic (tacrolimus) and Elidel (pimecrolimus). They are not very specific medications and affect immune function beyond the inflammation seen in eczema. They can be used in maintenance and flare-up regimens. They are known as immunomodulators because they change the way the immune system works. Because they are used topically and systemic absorption is low, the systemic immune system in an otherwise healthy individual is not thought to be at risk.

Crisaborole

Crisaborole is a unique topical prescription in that it is FDA-approved to treat children as young as three months old for mild to moderate atopic dermatitis; there is no corticosteroid involved and therefore no risk of skin thinning; there is also no black box warning as there is with the topical calcineurin inhibitors (e.g. Protopic).

Dupilumab

Dupilumab: This is a subcutaneous injection that patients are taught to give themselves at home. It has been a game-changer for many patients with moderate to severe atopic dermatitis.

Antihistamines

Anithistamines are not first-line treatments for atopic dermatitis. For people who are having trouble sleeping because of severe itching that is associated with atopic dermatitis, sedating antihistamines like diphenhydramine (Benadryl) and hydroxyzine (Atarax) may be helpful.

Oral Antibiotics

Atopic dermatitis reduces the skin's natural defenses, making it easier for the skin to become infected. In this case, physicians prescribe oral antibiotics based on characteristics of the suspected infection.

Oral Steroids

Oral corticosteroids, such as prednisone, prednisolone, and methylprednisolonel may be used for more severe flare-ups of eczema.

Though they are temporarily effective, oral steroids that are used for a long time have numerous side effects, including weight gain, thinning of the bones, and suppression of the immune system. Once a course of oral corticosteroids is complete, atopic dermatitis typically flares again. They are considered more of a temporary stop gap than a first-line defense. For example, a patient with a severe atopic dermatitis flare may be prescribed oral corticosteroids to help clear their symptoms in order to feel less self-conscious at a specific social event.

To reduce the risk of side effects, a doctor may prescribe a short course (for example, five days) of an oral steroid to calm the rash. Topical steroids can then be used on the remaining rash.

Coal Tar

Coal tar, which is actually made by melting coal, has long been a treatment for a variety of skin conditions. Shampoos and soaps containing coal tar can be used as second-line agents or adjunct therapy in atopic dermatitis.

Coal tar tends to work better on thickened skin that is not scaly. Sometimes it is used to ease very early symptoms of itching. However, coal tar can be very irritating to skin that's already inflamed. It is OK to try coal tar for mild cases of eczema, but you should stop immediately if you experience any increase in itching or redness of the rash.

Leukotriene Inhibitors

Leukotriene inhibitors, such as Singulair (montelukast) or Accolate (zafirlukast), are medications that may help reduce skin inflammation. These medications are often used to treat other allergy-related diseases, such as asthma and allergic rhinitis (seasonal allergies). Though they may be recommended by some, there is currently no good data that shows that leukotriene inhibitors improve atopic dermatitis.

Other Immune-Suppressing Medications

Many medications are used off-label to treat eczema that is refractory to FDA-approved medications. Some of these are immune suppressing medications that have been used at higher doses to treat transplant and cancer patients. These medications include:

  • Cyclosporine
  • Methotrexate
  • Azathioprine
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  • "Elidel Information." FDA.gov. 22 Sep 2007 
  • "Protopic Information." FDA.gov. 22 Sep 2007