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Atopic dermatitis, usually called eczema, is one of the most common conditions encountered in dermatology, with itch typically the paramount symptom. Treating atopic dermatitis usually starts with a gradual escalation of treatments up the therapeutic ladder.
Topical Therapies For Atopic Dermatitis
Emollients and Skin Care. The use of moisturizers on a regular basis and the avoidance of skin irritants is a first-line intervention for eczema.
Topical Steroids. Topical glucocorticoids are often employed on symptomatic eczema plaques.
Topical Calcineurin Inhibitors. Topical calcineurin inhibitors, such as tacrolimus and pimecrolimus, are also often used as first-line therapies, especially in areas such as the face and skin folds where the use of steroids should be minimized.
Other Topicals. Other topical medications such as topical doxepin, coal tar preparations, menthol-containing lotions, and pramoxine are often used as well.
Antibacterials. Dilute bleach baths, Hibiclens, and other antibacterial washes are sometimes utilized to reduce skin carriage of bacteria, which can contribute to or perpetuate eczema.
Systemic Agents For Atopic Dermatitis
Antihistamines. Both sedating and non-sedating antihistamines are often used to help with the pruritus of atopic dermatitis.
Antibiotics. Superinfection of eczematous plaques with S. aureus and other bacteria is common. Measures to reduce skin carriage can sometimes result in improvement in atopic dermatitis. This can include oral antibiotics or topical treatments as described above.
Systemic Steroids. Systemic glucocorticoids can be very helpful in the short-term in reducing symptoms, but rebound is common, and side-effects limit the long-term use of these agents.
Anti-depressants. SSRIs such as fluvoxamine, sertraline and paroxetine can relieve symptoms of itch, as can the TCA doxepin.
Immunosuppressants. Cyclosporine A has a long history of use for atopic dermatitis, as does azathioprine, though concern over long-term side-effects may limit their utilization.
Biologics. Dupilomab is a biologic that inhibits IL-4 and IL-13 and is approved for the treatment of moderate-to-severe atopic dermatitis.
Light Therapy. UVB light therapy is a rewarding treatment in many cases of atopic dermatitis, either administered in the doctor’s office with a light box or excimer laser, or at home with a home light box.
Consult your dermatologist to discuss your treatment options for atopic dermatitis (eczema).