Topicals begin with a course of topical steroids, but also include options for nonsteroidal agents, such as pimecrolimus or tacrolimus ointments and creams. Topical crisaborole can also be used for mild to moderate eczema in children and adults. Oral medications include many of the old-school immunosuppressants, such as methotrexate, cyclosporin and azothiaprine, and are becoming used less often due to their side effects and the advent of better drugs. Dupilumab is an injectable therapy, which is used to treat moderate to severe disease. The therapeutic treatment of atopic dermatitis includes moisturizers, topical steroids, topical calcineurin inhibitors, crisaborole phototherapy, including narrowband UVB. Dupilumab, azothiaprine, mycophenolate, mofetil, methotrexate omalizumab, tofacitinib, rituximab, interferon gamma, and IVG. Adjunctive therapies include wet wraps, open wet dressings, and soaks combined with topical steroids for acute exacerbations. Dilute bleach paths, leukotriene antagonists, vitamin D supplements, probiotics for primary prevention, oral anti-histamines for sedative and anti-itching effects and topical or oral sodium cromoglycate. Treatment of associated fungal viral and bacterial infections is also important. Other rarely used treatments include coal tar, hydroxychloroquine, extra corporal photo chemotherapy. There are also many treatments in the pipeline, including JAK kinase inhibitors, such as topical tofacitinib and nemolizumab, which acts on the aisle 31 receptor. Systemic steroids can be used for severe acute flares in the short term, although a rebound flare is more likely to occur. Cyclosporin can also be used in the short and intermediate terms of disease flares.
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