Medications
(1) Topical Steroids are used for treatment, depending upon the severity of the patient’s disease. Topical steroids help decrease skin inflammation and itching. They range in potency from weak to extremely strong. The potential for side effects with these products is low, provided they are used appropriately. For this reason, it is important to follow carefully the instructions given to you by your Dermatologist. For instance, some areas of the body such as the face, underarms, and groin area, will not tolerate strong topical steroids because these areas are sensitive and more prone to developing side effects (such as thinning of the skin). But for the most part, topical steroids are safe and very useful for Atopic Dermatitis. One other important piece of info regarding topical steroids is that your skincan develop tolerance (i.e. it “gets smart to the steroid”) if the medication is used for an extended period and continuously. Therefore, when your dermatitis is well controlled, do not continue using the topical steroid regularly. Instead, taper down with less frequent applications, and if possible, try to stop using the topical steroid for a while. In this way, you can “keep ahead” of your dermatitis, and the medication will show continued usefulness over a longer period. There are many types of topical steroids, and they come in various vehicles (e.g. ointment, foam, cream, gel etc.). Your Dermatologist will choose the one(s) that will work best for your situation. Many products are in generic form and are inexpensive whereas others are more expensive. Here are a few examples:
Super Potent: Halobetasol propionate, Clobetasol Propionate
Strong: Fluocinonide, Halcinonide
Medium: Triamcinalone, Mometasone
Mild: Desonide, Hydrocortisone
(2) Antihistamines can be utilized for itch control. Your Dermatologist might employ these safe and effective medications. The best ones do not cause excessive sleepiness, and these include Allegra (Fexofenadine), Claritin (Loratadine), Zyrtec (Cetirizine) and Xyzal (Levocetirizine). Others such as Benadryl (Diphenhydramine) can be helpful but tend to cause more drowsiness.
(3) Antibiotics are sometimes prescribed if the skin is heavily affected as bacteria tend to colonize areas of dermatitis. Decreasing those bacteria counts can help the dermatitis.
(4) Other non-steroid containing topical products are also available and may be prescribed. Examples include Eucrisa (Crisaborole), Elidel (Pimecrolimus), Protopic (Tacrolimus) and Opzelura (Ruxolitinib). They tend to be safe and can be used more frequently. They can be expensive.
(5) Steroids (such as Prednisone and Prednisolone) might be necessary from time to time, especially for patients going through particularly bad flare ups of Atopic Dermatitis. Steroids are good for short bursts but are not used for long term treatment.
(6) Stronger Medications that are taken by mouth or injection (known as “systemic treatments”) are sometimes extremely useful and life-changing for patients that have more severe Atopic Dermatitis. These are typically utilized when other treatments have failed. Examples include Dupixent (Dupilumab), Adbry (Tralokinumab), Rinvoq,(Upadacitinib), Methotrexate, Azathioprine and Cyclosporine Your Dermatologist can help you decide if any of these medications are necessary for you.