Atopic Dermatitis Medications: Topicals, Steroids, and Other Types to Know

Instead, treatment helps to reduce the symptoms of eczema (particularly itchiness) and establish long-lasting disease control (more than half of all children with eczema will outgrow it by the age of 12, though there is no cure for childhood eczema, either). The ultimate goal of treatment is to allow people with the condition to resume their normal daily functions at work, home, or school.

Eczema treatment plans often include at-home skin-care routines, such as moisturizing the skin. “Daily moisturization can have a benefit in preventing an eczema flare, but may not be adequate once a flare occurs,” says Kanwaljit K. Brar, MD, a pediatric allergist and immunologist at NYU Langone in New York City.

Prescription medications play a vital role in reducing inflammation and repairing the skin barrier. There are a number of different types of medications for atopic dermatitis, including:

  • Topical medications (creams, ointments, lotions) (1)
  • Oral immunosuppressants (2,3)
  • Self-administered injectable drugs

Topical Steroids for Treating Atopic Dermatitis

Topical treatments (or “topicals”) are medications that are applied to the skin to reduce or control eczema symptoms and inflammation. (1)

Corticosteroids, also known simply as steroids, are a first-line anti- inflammatory topical treatment for atopic dermatitis. (4) These drugs relieve itch and reduce redness; additionally, depending on the preparation, they can also help combat dry skin.

What Do Atopic Dermatitis and Other Eczema Types Look Like?

Topical steroids come in various forms — ointments, creams, lotions, sprays, gels, and oils. They also come in various strengths, which range from class 1 (super potent) to class 7 (least potent). (1)

Importantly, a higher steroid concentration does not necessarily mean higher potency, and the vehicles in which the drugs are prepared (creams versus lotions, for example) can also significantly impact strength. You can’t tell just by the name of the steroid how potent it is. (4)

Class 1 (super potent) medications include: (1)

  • 0.05 percent clobetasol propionate — Clobex (lotion, spray, shampoo), Olux E (foam), and Temovate E (emollient, cream, ointment, gel)
  • 0.05 percent halobetasol propionate — Ultravate (cream)
  • 0.1 percent fluocinonide — Vanos (cream)

Class 2 (potent) medications include:

  • 0.05 percent diflorasone diacetate — ApexiCon E (cream)
  • 0.05 percent halobetasol propionate — Elocon (ointment)
  • 0.01 percent fluocinonide — Halog (ointment)
  • 0.25 percent desoximetasone — Topicort (cream, ointment)

Class 3 (upper mid-strength) medications include:

  • 0.05 percent fluocinonide — Lidex-E (cream)
  • 0.05 percent desoximetasone — Topicort LP (cream)

Class 4 (mid-strength) medications include:

  • 0.1 percent clocortolone pivalate — Cloderm (cream)
  • 0.1 percent mometasone furoate — Elocon (cream)
  • 0.1 percent triamcinolone acetonide — Aristocort A (cream) and Kenalog (ointment)
  • 0.1 percent betamethasone valerate — Valisone (ointment)
  • 0.05 percent desoximetasone — Topicort (cream, ointment)

Class 5 (lower mid-strength) medications include:

  • 0.05 percent fluticasone propionate — Cutivate (cream, lotion)
  • 0.1 percent prednicarvate — Dermatop (cream)
  • 0.1 percent hydrocortisone butyrate — Locoid (cream, ointment)
  • 0.1 percent hydrocortisone probutate — Pandel (cream)
  • 0.1 percent triamcinolone acetonide — Kenalog (lotion)
  • 0.025 percent fluocinolone acetonide — Synalar (cream)

Class 6 (mild) medications include:

  • 0.05 percent alclometasone dipropionate — Aclovate (cream, ointment)
  • 0.05 percent desonide — Verdeso (foam) and Desonate (gel)
  • 0.025 percent triamcinolone acetonide — Aristocort A (cream) and Kenalog (ointment)
  • 0.01 percent fluocinolone acetonide — Derma-Smoothe/FS (body or scalp oil)

Class 7 (least potent) medications include:

  • 2/2.5 percent— Nutracort (lotion) and Synacort (cream)
  • 0.5–1 percent hydrocortisone — Cortaid (cream, spray, ointment)

These steroids should only be used intermittently to reduce inflammation, and they should be followed with a moisturizer.

“Topical steroids do have side effects with prolonged use, such as skin thinning, stretch marks, and the development of telangiectasias [spider veins],” Dr. Brar says. Less commonly, they can also cause more serious side effects, including glaucoma and cataracts, adrenal suppression, and topical steroid addiction and withdrawal, among other things. (1) “However, they are currently the most effective treatment of skin inflammation and should be used under the guidance of an experienced doctor,” she adds.

Other Topical Medications for Treating Atopic Dermatitis

Topical calcineurin inhibitors (TCIs) are a unique class of nonsteroidal anti- inflammatory topical agents that work by blocking an overactive immune system when absorbed into the skin. (1)

The drugs are typically prescribed when topical steroids are ineffective (though they are not necessarily more effective than steroids in general) or if a patient has eczema in areas that aren’t safe for long-term steroid use, such as the eyelids. (1,5)

The two types of TCIs approved by the U.S. Food and Drug Administration (FDA) are Protopic (tacrolimus) and Elidel (pimecrolimus). (1) While TCIs don’t carry the same side effects as topical steroids, they may cause a mild burning or stinging sensation when first applied.

In 2016, the FDA approved another type of topical medication for eczema. The medication, Eucrisa (crisaborole), is in a class of drugs known as PDE4 inhibitors that work by blocking the enzyme phosphodiesterase 4, which is involved in the body’s inflammatory processes. (1,7)

In clinical trials, Eucrisa helped patients get clear or almost clear skin after 28 days of treatment. Serious side effects include hypersensitivity reactions to Eucrisa’s active ingredient, crisaborole. The most common side effect is application site pain, including burning or stinging.

Oral and Injected Medications for Atopic Dermatitis

Anti-inflammatory medications aren’t limited to topical applications — some are also systemic oral or injected medications, which are classified as immunosuppressants.

Immunosuppressants work by preventing the body’s immune system from activating the inflammatory skin response that’s the hallmark of atopic dermatitis, resulting in less itching, redness, and skin barrier problems. (8)

The most commonly used immunosuppressants for atopic dermatitis are cyclosporine, azathioprine, methotrexate, and mycophenolate mofetil. When used for atopic dermatitis, immunosuppressants are considered “off-label” because they are not approved by the FDA to specifically treat the condition.

Though they are effective for some people, these systemic steroids are not advised for long-term use. The drugs carry a number of potentially serious side effects, including increased risk of certain cancers, increased blood pressure (cyclosporine), increased risk of kidney damage (cyclosporine and methotrexate), and risk of liver damage (methotrexate).

Biologic drugs, or biologics, are another type of systemic medication prescribed for atopic dermatitis. (9) The drugs work by blocking the activity of the protein interleukin, which normally helps the immune system fight off pathogens with inflammation but is triggered erroneously (and without the presence of pathogens) in people with atopic dermatitis and other inflammatory conditions.

Dupixent (dupilumab) is the first biologic approved for the treatment of atopic dermatitis. In clinical trials, more than half of people who took Dupixent — which is injected under the skin every other week — had their symptoms reduced by 75 percent over the course of 16 weeks.

In 2020 the FDA expanded its approval of Dupixent to children who are 6 years old and above.

Side effects for the biologic include:

  • Ocular issues, such as conjunctivitis (pink eye)
  • Injection site reactions
  • Cold sores on the mouth or lips

Other Medications for Treating Atopic Dermatitis

In some cases, antihistamines may be used to treat specific issues associated with atopic dermatitis. (5)

Antihistamines can help relieve itching in the case of hives and other allergic conditions, but the drugs don't relieve itching associated with atopic dermatitis, because the underlying cause is different.

Instead, classical antihistamines, which cause drowsiness and are the active ingredient in over-the-counter sleep aids, are occasionally used to help people with atopic dermatitis get a better night's sleep.

People with atopic dermatitis are at an increased risk of infections, especially bacterial skin infections from staphylococcus and streptococcus bacteria. (10) These infections worsen eczema symptoms and must be treated with antibiotics, such as Keflex (cephalexin) or dicloxacillin, before eczema can be brought back under control. (5)

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