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Atopic Dermatitis Treatments: Drug and Nondrug Therapies

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There is no cure for atopic dermatitis, but there are treatments that can ease symptoms like itch and inflammation and reduce flare-ups.

Medications, moisturizers, and at-home skin-care routines are all part of an effective treatment plan.

Topical corticosteroids (steroids) are the standard, go-to treatment for atopic dermatitis flare-ups.

Applied directly to the affected areas of skin, these ointments, creams, or lotions can reduce inflammation and itch.

Topical corticosteroids come in varying degrees of strength — with 1 being the most powerful and 7 being the weakest. For example, the ultra-high-potency steroid clobetasol is a class 1 medication, while over-the-counter hydrocortisone creams are in the least potent class 7.

Topical corticosteroids should not be used as moisturizers and should only be applied to areas of the skin that are affected by atopic dermatitis, as often as your doctor recommends.

With excessive use, these drugs can thin the skin, cause spider veins, or result in stretch marks, among other side effects.

Rarely, topical corticosteroids can be absorbed into the skin and enter the bloodstream, causing side effects that can affect the whole body. These more severe side effects may include:

  • Eye problems (glaucoma and cataracts)
  • Slowed growth in children
  • Hypothalamic-pituitary-adrenal axis suppression
  • Topical steroid withdrawal
  • Tachyphylaxis, where the skin becomes tolerant to the steroid and it doesn’t work anymore

Systemic Corticosteroids

If topical corticosteroids aren’t working, or in more severe cases of atopic dermatitis, doctors may in rare cases prescribe a systemic (whole body) corticosteroid, taken by mouth or injected.

Doctors only recommend taking systemic corticosteroids for short periods of time, because these drugs can result in a “rebound effect,” in which symptoms return and can be even worse once you stop taking these medications. Using oral steroids for more than a month can also cause serious side effects including:

  • An increase in bacterial, fungal, and viral infections
  • Skin thinning, stretch marks, and acne
  • Hair loss
  • Weight gain
  • Glaucoma
  • Cataracts
  • High blood pressure
  • Gastrointestinal (stomach) issues
  • Stunted growth in children
  • Irregular menstruation
  • Osteoporosis
Topical calcineurin inhibitors (TCIs) are another category of prescription medication for atopic dermatitis that includes tacrolimus (Protopic) and pimecrolimus (Elidel).

TCIs control inflammation and reduce atopic dermatitis flare-ups by suppressing the immune system. They don’t contain steroids, and they're typically prescribed when topical steroids are ineffective or aren’t well tolerated. They can also be prescribed for delicate areas of the skin, such as the eyelids or groin folds, where it’s important to prevent thinning of the skin.

In 2006, based on animal studies and oral ingestion of TCIs, the U.S. Food and Drug Administration (FDA) added a box warning for TCIs because of a potential increased risk of lymphoma. However, a systematic review and meta-analysis published in 2023 found moderate-certainty evidence showing that TCIs don’t increase the risk of cancer among people with atopic dermatitis.

PDE4 inhibitors work by blocking an enzyme called phosphodiesterase 4 (PDE4) from producing too much inflammation in the body. Until recently, there was only one PDE4 inhibitor on the market that was approved by the FDA for atopic dermatitis: crisaborole (Eucrisa).

 However, in July 2024, another PDE4 inhibitor, roflumilast (Zoryve), was approved for eczema in patients 6 years old and older.

Topical JAK inhibitors, specifically the skin creams delgocitinib (Anzupgo) and ruxolitinib (Opzelura) work by blocking enzymes involved in the path of several immune system messengers in the blood and skin that can lead to inflammation.

The FDA added a box warning to this medication because of the risk of serious infections and other potentially severe complications.

Aryl hydrocarbon receptor agonists are a new steroid-free option for atopic dermatitis. In December 2024, the FDA approved an aryl hydrocarbon receptor agonist called tapinarof cream 1 percent (Vtama) to treat atopic dermatitis in adults and children ages 2 or older.

 Vtama works by decreasing inflammation and normalizing proteins on the skin barrier to help the skin barrier function properly.

Several oral and injectable medications have also been approved to help manage atopic dermatitis symptoms such as itching.

Biologics

Biologics target specific parts of the immune system that contribute to inflammatory diseases such as atopic dermatitis.

 Two biologic drugs have been approved by the FDA to treat atopic dermatitis. Both are injected subcutaneously (through the skin), and can be self-administered.

Dupilumab (Dupixent) is approved to treat adults and children 6 months old and older with moderate to severe atopic dermatitis that hasn't responded well to topical medications. Dupilumab works by blocking the activity of certain inflammatory chemicals in the body.

The common side effects of dupilumab are generally mild, and they include:

  • Eyelid and eye inflammation
  • Injection site reactions
  • Cold sores
Tralokinumab-ldrm (Adbry) is approved to treat people 12 years old and older with moderate to severe atopic dermatitis that hasn't responded well to topical medications. It works by blocking a protein that plays a role in the body’s immune response that leads to inflammation of the skin.

The most common side effects of Adbry include:

  • Upper respiratory tract infections
  • Eye and eyelid inflammation
  • Reaction at the injection site
  • High eosinophil count (a type of white blood cell)
Lebrikizumab-lbkz (Ebglyss) was approved by the FDA in September 2024 for the treatment of atopic dermatitis in adults and children ages 12 and older.

 Ebglyss works by minimizing eczema-related inflammation in the body that can result in dry, itchy and irritated skin. The most common side effects of Ebglyss are eye and eyelid inflammation (including redness, swelling, and itching), reactions at the injection site, and shingles (herpes zoster).

Nemolizumab (Nemluvio) was approved in December 2024 by the FDA to treat moderate to severe atopic dermatitis in combination with topical corticosteroids or calcineurin inhibitors in patients ages 12 or older. This treatment is intended for people whose atopic dermatitis has not adequately improved with topical prescription treatments.

Nemluvio works by targeting a protein in the body that leads to itch and inflammation in atopic dermatitis. The most common side effects of Nemluvio in people with eczema include:

  • Headache
  • Hives
  • Joint pain
  • Muscle aches

Systemic Immunosuppressants

In moderate to severe cases of atopic dermatitis, doctors may prescribe a systemic immunosuppressant, such as cyclosporine (Neoral or Sandimmune), azathioprine, methotrexate (Trexall or Rasuvo), or mycophenolate mofetil (CellCept).

 These drugs help control or suppress the immune system to stop the itch-scratch cycle and allow the skin to heal.

When prescribed for atopic dermatitis, immunosuppressants are considered “off-label” because they are not approved by the FDA for this use.

These drugs can have potentially serious side effects, such as an increased risk of developing dangerous infections and cancers, and are not recommended for long-term use.

Oral JAK Inhibitors

JAK inhibitors are a relatively new class of oral immunomodulators that can block immune system signals and thereby reduce inflammation and itch.

The FDA has approved two oral JAK inhibitors, upadacitinib (Rinvoq) and abrocitinib (Cibinqo), to treat moderate to severe atopic dermatitis.

Rinvoq and Cibinqo are not recommended for use in combination with other JAK inhibitors, biologics, or other immunosuppressants. The FDA has placed a box warning on these medications for potentially increasing the risk of all-cause mortality, serious infections, certain cancers (including lymphoma), heart attack, stroke, and thrombosis (blood clots).

Here’s a quick roundup of the different types of medications discussed earlier in the article to help you compare them more easily:

Antihistamines

Doctors may recommend certain antihistamines for atopic dermatitis to make it easier to sleep through the night, and to reduce inflammation and itch if you have allergies.

Light Therapy

Light therapy (phototherapy) using ultraviolet waves can help improve itch and inflammation. The treatment is typically prescribed for people whose atopic dermatitis hasn’t improved with topical treatments.

Skin improvements usually don’t occur immediately, but instead become evident after one to two months of treatments.

Sunburns, skin tenderness, and premature skin aging are common side effects. Less common potential side effects include cataracts and skin eruptions.

Wet-Wrap Therapy

Wet wrap therapy can help rehydrate and calm the skin during intense eczema flares. It can also help topical medications work better. In wet-wrap therapy, fabric wraps are soaked in water and applied to the affected skin, typically after bathing, moisturizing, and applying medication. Talk to your doctor before you try wet wrap therapy.

In addition to seeking help from a doctor, people with atopic dermatitis may be able to take a few steps on their own to reduce itching and the need for medication.

These measures include:

  • Keeping fingernails short and wearing gloves at night to avoid scratching the skin

  • Moisturizing skin frequently with ointments (petroleum jelly), creams, and lotions that are free of alcohol, fragrances, and dyes
  • Using a humidifier, particularly if the air is dry
  • Avoiding skin irritants, such as wool or man-made fibers (wear soft cotton clothing instead), strong soaps and detergents, and situations or environments that cause sweating

  • Avoiding airborne allergens, such as pollen, pet dander, and dust mites
When bathing, it's important to minimize time in the tub or shower (aim for no more than 10 to 15 minutes) and to use cool or lukewarm water. Use gentle body washes and cleansers, and avoid scrubbing or toweling off for too long.

Also be sure to apply a moisturizer immediately after drying off.

While you can’t cure atopic dermatitis naturally, some people have found relief with the following home treatments:

  • Adding a quarter cup of baking soda, a cup of table salt, a cup of vinegar, fragrance-free bath oils, or a half cup of bleach to a full tub of bathwater

  • Managing stress through massage, yoga, qigong, tai chi, mindfulness meditation, hypnosis, or biofeedback

  • Acupuncture and acupressure
  • Using oils like coconut oil and sunflower seed oil (ask your doctor before using any new product on your skin, including oils)
Food allergies are common among people with atopic dermatitis — about 30 percent of people with the skin condition also have food allergies. Allergies and food sensitivities can also trigger atopic dermatitis flares, but this is much more common in children than adults. Common food allergies and food sensitivities among people with atopic dermatitis include seafood, peanuts, dairy, eggs, sugar, alcohol, and gluten.

While elimination diets are generally not recommended for atopic dermatitis, the National Eczema Association recommends getting tested for food allergies before removing any foods from your diet.

In addition to avoiding known food allergies, experts say an anti-inflammatory diet can help some people with atopic dermatitis. This diet involves avoiding trans fats (hydrogenated oils, margarine, fried foods), saturated fats (red meats, full-fat dairy foods, butter, and poultry skin), refined carbs (white rice, white bread, and white pasta), and added sugars, and eating more omega-3 fatty acids (fatty fish, flaxseed, walnuts), green leafy vegetables, fruits, and whole grains.

Supplements for Atopic Dermatitis

Some people who have atopic dermatitis report that certain vitamins and dietary supplements offer some relief from symptoms. These commonly include:

  • Fish oil
  • Vitamin D
  • Vitamin C
  • Zinc
  • Selenium
  • Melatonin
  • Turmeric
  • Primrose Oil
  • CBD
  • Prebiotics and probiotics

There isn’t a lot of research or evidence to prove that any vitamins or supplements are safe and effective for treating atopic dermatitis, and some may be harmful when taken with prescription medication. Always talk to your doctor before taking a new vitamin or supplement.

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