Fast Five Quiz: Atopic Dermatitis

Richard P. Vinson, MD

Disclosures

February 11, 2020

The application of skin moisturizers is not only the initial treatment for patients with AD, but is also an integral part of maintenance therapy and the prevention of disease flare-ups. 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 initiated after symptoms of AD continue despite the use of skin moisturizers. If nonprescription topical corticosteroid creams or ointments prove ineffective, physicians may prescribe topical triamcinolone (0.1% for adults and 0.025% for children), which has been shown to have excellent responsiveness.

A targeted biologic therapy (dupilumab) has been approved by the US Food and Drug administration to treat AD when moisturizers, topical corticosteroids, or topical immunomodulatory therapies are unsuccessful in patients with moderate to severe AD. Dupilumab, a bimonthly subcutaneous injection, is a monoclonal antibody that inhibits interleukin (IL)-4 and IL-13 signaling. Dupilumab is approved for use in patients aged 12 years or older, and it is emerging as first-line treatment for AD.

ANB020, or anti-IL-33 therapy, blocks IL-4 cytokine responses by acting on multiple cell types—Th2 cells, basophils, and type 2 innate lymphoid cells. Although larger phase trials are required, a small phase 2a study showed promise in the treatment of patients with AD in whom topical treatment was ineffective.

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 aged 2 years or older 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 claims of increased risk for cancer.

Crisaborole ointment 2% is a phosphodiesterase-4 inhibitor that is approved for use in patients aged 2 years and older with mild to moderate AD.

Learn more about medical management of AD.

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