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Atopic Dermatitis – Treatment

February 7, 2021


“What else is included in the treatment of atopic dermatitis? Topical anti-inflammatory agents should be considered for mild to moderate disease, including a topical steroid of appropriate scent. High potency can be used for thickened or like kind of wide pox areas on the hands and feet, while low potency can be used for thinner lesions, genitalia, face and the body folds. This can be used one to two times a day until the eczema is cleared. Topical steroids can come in many vehicles: ointments minimize stinging and creams are preferable. For the scalp, oils, foams and solutions can be useful. To maximize adherence to the treatment plan, it is important to address patient and parental concerns about topical steroids. Wet rags and tap water compresses followed by the application of topical steroids can speed the improvement of acute flares or eczema. Second line treatment includes topical calcineurin inhibitors, such as tacrolimus and [?] to help them primarily thin lesions on the face, intertriginous areas, and body folds.

To control sub-clinical inflammation and prevent flares, a high level of maintenance with intermittent use of a topical steroid and a topical calcineurin inhibitor to the locations of the eczema once clear can help. Phototherapy and systemic anti-inflammatory agents can also be used. For phototherapy, narrowband UVB, induces remission. However, UVA one may also be used for acute flares and a combination UVA UVB broadband may be use. Systemic anti-inflammatory therapy should be restricted for recalcitrant, refractory and severe atopic dermatitis. Oral cyclosporin is a systemic agent that is very effective for atopic dermatitis. However, its use is limited by side effects, which include possible nefrotoxicity. Other systemic therapy, such as methotrexate azathioprine and mycophenolate mofetil have better safety profiles yet less of a dramatic benefit. Systemic steroids should be avoided in eczema due to the high potential of rebound or exacerbations and unacceptable side effects. They may be used, however, in severe acute flares with a specific trigger that are resistant to topicals. A short course of systemic steroids should be transitioned to topicals, phototherapy and other systemic agents. Adjunctive pharmacologic therapy includes sedating anti-histamines such as doxepin, hydroxizine and diphenhydramine, which are given when result when resting to help break the itch scratch cycle and are particularly useful if the itching interrupts sleep. Controlled trials of antibiotics aimed at reducing colonization, probiotics leukotriene antagonist and non-sedating anti-histamines, have not shown consistent improvement or efficacy as mono therapies for atopic dermatitis. In addition, dilute bleach bath sodium hypochlorite may be beneficial at reducing bacterial colonization and predisposition to infection.”

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