The application of skin moisturizers is not only the initial treatment for patients with AD, it is also an integral part of maintenance therapy and the prevention of disease flare-ups, per the AAD. Effective emollients for AD are available in both nonprescription and prescription formulations.
An effective treatment method to improve skin hydration is to recommend that patients take 5-minute lukewarm baths and apply an emollient immediately thereafter, while skin is wet, to seal in the moisture.
Topical corticosteroid ointments are usually initiated after symptoms of AD continue if the use of skin moisturizers does not provide adequate control. If nonprescription topical corticosteroid creams or ointments prove ineffective, physicians may prescribe a low-potency (Class VI or VII in mild cases) or intermediate-potency (Class III, IV, or V in moderate cases) topical steroid cream or ointment. Only low-potency topical steroids should be used on the face, axillae, groin, and intertriginous areas owing to increased absorption and a greater potential for local steroid adverse effects.
Dupilumab, a monoclonal antibody that inhibits interleukin (IL)-4 and IL-13, has been approved by the US Food and Drug Administration (FDA) to treat AD. Dupilumab is indicated for patients aged 6 months or older with moderate to severe AD not adequately controlled with topical prescription therapies or when those therapies are not advisable. Dupilumab may also have an ameliorative effect on asthma and other allergic disorders. Trials involving lebrikizumab (which selectively target IL-13) and nemolizumab (targeting IL-31) hold promise in the treatment of this challenging condition. The Janus kinase inhibitors abrocitinib and upadacitinib are approved by the FDA for use in AD as is tralokinumab (which selectively targets IL-13).
Immunomodulatory medications, such as tacrolimus ointment 0.1% for adults or 0.03% for children and pimecrolimus 1% cream, are approved for use in patients with moderate to severe AD. These calcineurin inhibitors are second-line therapy and are currently under a black box warning in the United States owing to the potential risk for the development of malignancies; however, little evidence exists to support the association of calcineurin inhibitors with risk of developing cancer.
Crisaborole ointment 2% is a phosphodiesterase-4 inhibitor that is approved for use in patients with mild to moderate AD.
Learn more about medical management of AD.
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Cite this: Richard P. Vinson, William James. Fast Five Quiz: Atopic Dermatitis - Medscape - Feb 09, 2023.