Atopic dermatitis medical therapy

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Shalinder Singh, M.B.B.S.[2] Ogechukwu Hannah Nnabude, MD

Overview

The mainstay of treatment for atopic dermatitis depends upon the severity of the disease. The treatment involves a combination of conservative and medical therapy. The goals of treatment include elimination of aggravating factors, skin barrier function repair, maintaining skin hydration and pharmacologic treatment of skin inflammation. Pharmacologic medical therapies for atopic dermatitis can be classified according to several severity scales including SCORAD index, the eczema area and severity index (EASI), and the patient-oriented eczema measure (POEM).

Conservative Therapy

Elimination of exacerbating factors Maintaining skin hydration Controlling pruritus
  • Emollients and moisturizers
  • Bathing practices
    • Warm soaking baths or showers using mild or soap-free cleansers

Medical Therapy

  • Pharmacologic medical therapies for atopic dermatitis can be classified according to several severity scales including SCORAD index, the eczema area and severity index (EASI), and the patient-oriented eczema measure (POEM) which includes characteristics of the rash, questions about itch, sleep, impact on daily activities, and persistence of disease.[3]

Atopic dermatitis

Other Drugs for atopic dermatitis:

Adjuvant treatment:

Management of Infections:

Controlling pruritus:

Potential systemic therapies (not yet approved):[3]

  • JAK inhibitors:
    • Abrocitinib (JAK1)
    • Gusacitinib (pan-JAK, SYK)
    • Tofacitinib (JAK1 and JAK3)
    • Upadacitinib (JAK1)
  • Interleukin-13 receptor antibodies
  • nterleukin-22 receptor antibody
  • Interleukin-31 receptor A antibody
  • Interleukin-33 receptor A antibody
  • Phosphodiesterase-4 inhibitor

References

  1. Krakowski AC, Eichenfield LF, Dohil MA (October 2008). "Management of atopic dermatitis in the pediatric population". Pediatrics. 122 (4): 812–24. doi:10.1542/peds.2007-2232. PMID 18829806.
  2. Krakowski AC, Eichenfield LF, Dohil MA (October 2008). "Management of atopic dermatitis in the pediatric population". Pediatrics. 122 (4): 812–24. doi:10.1542/peds.2007-2232. PMID 18829806.
  3. 3.0 3.1 3.2 3.3 3.4 3.5 Ständer, Sonja; Ropper, Allan H. (2021). "Atopic Dermatitis". New England Journal of Medicine. 384 (12): 1136–1143. doi:10.1056/NEJMra2023911. ISSN 0028-4793.
  4. Krakowski AC, Eichenfield LF, Dohil MA (October 2008). "Management of atopic dermatitis in the pediatric population". Pediatrics. 122 (4): 812–24. doi:10.1542/peds.2007-2232. PMID 18829806.
  5. Aalto-Korte K, Turpeinen M (August 1995). "Pharmacokinetics of topical hydrocortisone at plasma level after applications once or twice daily in patients with widespread dermatitis". Br. J. Dermatol. 133 (2): 259–63. PMID 7547394.
  6. Ruzicka T, Bieber T, Schöpf E, Rubins A, Dobozy A, Bos JD, Jablonska S, Ahmed I, Thestrup-Pedersen K, Daniel F, Finzi A, Reitamo S (September 1997). "A short-term trial of tacrolimus ointment for atopic dermatitis. European Tacrolimus Multicenter Atopic Dermatitis Study Group". N. Engl. J. Med. 337 (12): 816–21. doi:10.1056/NEJM199709183371203. PMID 9295241.
  7. Ruzicka T, Bieber T, Schöpf E, Rubins A, Dobozy A, Bos JD, Jablonska S, Ahmed I, Thestrup-Pedersen K, Daniel F, Finzi A, Reitamo S (September 1997). "A short-term trial of tacrolimus ointment for atopic dermatitis. European Tacrolimus Multicenter Atopic Dermatitis Study Group". N. Engl. J. Med. 337 (12): 816–21. doi:10.1056/NEJM199709183371203. PMID 9295241.
  8. Aalto-Korte K, Turpeinen M (August 1995). "Pharmacokinetics of topical hydrocortisone at plasma level after applications once or twice daily in patients with widespread dermatitis". Br. J. Dermatol. 133 (2): 259–63. PMID 7547394.
  9. Ruzicka T, Bieber T, Schöpf E, Rubins A, Dobozy A, Bos JD, Jablonska S, Ahmed I, Thestrup-Pedersen K, Daniel F, Finzi A, Reitamo S (September 1997). "A short-term trial of tacrolimus ointment for atopic dermatitis. European Tacrolimus Multicenter Atopic Dermatitis Study Group". N. Engl. J. Med. 337 (12): 816–21. doi:10.1056/NEJM199709183371203. PMID 9295241.
  10. Ruzicka T, Bieber T, Schöpf E, Rubins A, Dobozy A, Bos JD, Jablonska S, Ahmed I, Thestrup-Pedersen K, Daniel F, Finzi A, Reitamo S (September 1997). "A short-term trial of tacrolimus ointment for atopic dermatitis. European Tacrolimus Multicenter Atopic Dermatitis Study Group". N. Engl. J. Med. 337 (12): 816–21. doi:10.1056/NEJM199709183371203. PMID 9295241.
  11. Ruzicka T, Bieber T, Schöpf E, Rubins A, Dobozy A, Bos JD, Jablonska S, Ahmed I, Thestrup-Pedersen K, Daniel F, Finzi A, Reitamo S (September 1997). "A short-term trial of tacrolimus ointment for atopic dermatitis. European Tacrolimus Multicenter Atopic Dermatitis Study Group". N. Engl. J. Med. 337 (12): 816–21. doi:10.1056/NEJM199709183371203. PMID 9295241.
  12. Ruzicka T, Bieber T, Schöpf E, Rubins A, Dobozy A, Bos JD, Jablonska S, Ahmed I, Thestrup-Pedersen K, Daniel F, Finzi A, Reitamo S (September 1997). "A short-term trial of tacrolimus ointment for atopic dermatitis. European Tacrolimus Multicenter Atopic Dermatitis Study Group". N. Engl. J. Med. 337 (12): 816–21. doi:10.1056/NEJM199709183371203. PMID 9295241.
  13. 13.0 13.1 Ruzicka T, Bieber T, Schöpf E, Rubins A, Dobozy A, Bos JD, Jablonska S, Ahmed I, Thestrup-Pedersen K, Daniel F, Finzi A, Reitamo S (September 1997). "A short-term trial of tacrolimus ointment for atopic dermatitis. European Tacrolimus Multicenter Atopic Dermatitis Study Group". N. Engl. J. Med. 337 (12): 816–21. doi:10.1056/NEJM199709183371203. PMID 9295241.
  14. 14.0 14.1 Ruzicka T, Bieber T, Schöpf E, Rubins A, Dobozy A, Bos JD, Jablonska S, Ahmed I, Thestrup-Pedersen K, Daniel F, Finzi A, Reitamo S (September 1997). "A short-term trial of tacrolimus ointment for atopic dermatitis. European Tacrolimus Multicenter Atopic Dermatitis Study Group". N. Engl. J. Med. 337 (12): 816–21. doi:10.1056/NEJM199709183371203. PMID 9295241.
  15. Czech W, Bräutigam M, Weidinger G, Schöpf E (April 2000). "A body-weight-independent dosing regimen of cyclosporine microemulsion is effective in severe atopic dermatitis and improves the quality of life". J. Am. Acad. Dermatol. 42 (4): 653–9. PMID 10727313.
  16. Lyakhovitsky A, Barzilai A, Heyman R, Baum S, Amichai B, Solomon M, Shpiro D, Trau H (January 2010). "Low-dose methotrexate treatment for moderate-to-severe atopic dermatitis in adults". J Eur Acad Dermatol Venereol. 24 (1): 43–9. doi:10.1111/j.1468-3083.2009.03351.x. PMID 19552716.
  17. Berth-Jones J, Takwale A, Tan E, Barclay G, Agarwal S, Ahmed I, Hotchkiss K, Graham-Brown RA (August 2002). "Azathioprine in severe adult atopic dermatitis: a double-blind, placebo-controlled, crossover trial". Br. J. Dermatol. 147 (2): 324–30. PMID 12174106.
  18. Beck LA, Thaçi D, Hamilton JD, Graham NM, Bieber T, Rocklin R, Ming JE, Ren H, Kao R, Simpson E, Ardeleanu M, Weinstein SP, Pirozzi G, Guttman-Yassky E, Suárez-Fariñas M, Hager MD, Stahl N, Yancopoulos GD, Radin AR (July 2014). "Dupilumab treatment in adults with moderate-to-severe atopic dermatitis". N. Engl. J. Med. 371 (2): 130–9. doi:10.1056/NEJMoa1314768. PMID 25006719.
  19. Czech W, Bräutigam M, Weidinger G, Schöpf E (April 2000). "A body-weight-independent dosing regimen of cyclosporine microemulsion is effective in severe atopic dermatitis and improves the quality of life". J. Am. Acad. Dermatol. 42 (4): 653–9. PMID 10727313.
  20. Berth-Jones J, Takwale A, Tan E, Barclay G, Agarwal S, Ahmed I, Hotchkiss K, Graham-Brown RA (August 2002). "Azathioprine in severe adult atopic dermatitis: a double-blind, placebo-controlled, crossover trial". Br. J. Dermatol. 147 (2): 324–30. PMID 12174106.
  21. Beck LA, Thaçi D, Hamilton JD, Graham NM, Bieber T, Rocklin R, Ming JE, Ren H, Kao R, Simpson E, Ardeleanu M, Weinstein SP, Pirozzi G, Guttman-Yassky E, Suárez-Fariñas M, Hager MD, Stahl N, Yancopoulos GD, Radin AR (July 2014). "Dupilumab treatment in adults with moderate-to-severe atopic dermatitis". N. Engl. J. Med. 371 (2): 130–9. doi:10.1056/NEJMoa1314768. PMID 25006719.
  22. Czech W, Bräutigam M, Weidinger G, Schöpf E (April 2000). "A body-weight-independent dosing regimen of cyclosporine microemulsion is effective in severe atopic dermatitis and improves the quality of life". J. Am. Acad. Dermatol. 42 (4): 653–9. PMID 10727313.
  23. Lyakhovitsky A, Barzilai A, Heyman R, Baum S, Amichai B, Solomon M, Shpiro D, Trau H (January 2010). "Low-dose methotrexate treatment for moderate-to-severe atopic dermatitis in adults". J Eur Acad Dermatol Venereol. 24 (1): 43–9. doi:10.1111/j.1468-3083.2009.03351.x. PMID 19552716.
  24. Berth-Jones J, Takwale A, Tan E, Barclay G, Agarwal S, Ahmed I, Hotchkiss K, Graham-Brown RA (August 2002). "Azathioprine in severe adult atopic dermatitis: a double-blind, placebo-controlled, crossover trial". Br. J. Dermatol. 147 (2): 324–30. PMID 12174106.
  25. Beck LA, Thaçi D, Hamilton JD, Graham NM, Bieber T, Rocklin R, Ming JE, Ren H, Kao R, Simpson E, Ardeleanu M, Weinstein SP, Pirozzi G, Guttman-Yassky E, Suárez-Fariñas M, Hager MD, Stahl N, Yancopoulos GD, Radin AR (July 2014). "Dupilumab treatment in adults with moderate-to-severe atopic dermatitis". N. Engl. J. Med. 371 (2): 130–9. doi:10.1056/NEJMoa1314768. PMID 25006719.
  26. Czech W, Bräutigam M, Weidinger G, Schöpf E (April 2000). "A body-weight-independent dosing regimen of cyclosporine microemulsion is effective in severe atopic dermatitis and improves the quality of life". J. Am. Acad. Dermatol. 42 (4): 653–9. PMID 10727313.
  27. Lyakhovitsky A, Barzilai A, Heyman R, Baum S, Amichai B, Solomon M, Shpiro D, Trau H (January 2010). "Low-dose methotrexate treatment for moderate-to-severe atopic dermatitis in adults". J Eur Acad Dermatol Venereol. 24 (1): 43–9. doi:10.1111/j.1468-3083.2009.03351.x. PMID 19552716.
  28. Hanifin JM, Schneider LC, Leung DY, Ellis CN, Jaffe HS, Izu AE, Bucalo LR, Hirabayashi SE, Tofte SJ, Cantu-Gonzales G (February 1993). "Recombinant interferon gamma therapy for atopic dermatitis". J. Am. Acad. Dermatol. 28 (2 Pt 1): 189–97. PMID 8432915.
  29. Simon D, Hösli S, Kostylina G, Yawalkar N, Simon HU (January 2008). "Anti-CD20 (rituximab) treatment improves atopic eczema". J. Allergy Clin. Immunol. 121 (1): 122–8. doi:10.1016/j.jaci.2007.11.016. PMID 18206507.
  30. Lane JE, Cheyney JM, Lane TN, Kent DE, Cohen DJ (January 2006). "Treatment of recalcitrant atopic dermatitis with omalizumab". J. Am. Acad. Dermatol. 54 (1): 68–72. doi:10.1016/j.jaad.2005.09.030. PMID 16384758.
  31. Jacobi A, Antoni C, Manger B, Schuler G, Hertl M (March 2005). "Infliximab in the treatment of moderate to severe atopic dermatitis". J. Am. Acad. Dermatol. 52 (3 Pt 1): 522–6. doi:10.1016/j.jaad.2004.11.022. PMID 15761436.
  32. Navarini AA, French LE, Hofbauer GF (November 2011). "Interrupting IL-6-receptor signaling improves atopic dermatitis but associates with bacterial superinfection". J. Allergy Clin. Immunol. 128 (5): 1128–30. doi:10.1016/j.jaci.2011.09.009. PMID 21962991.
  33. Bamford JT, Ray S, Musekiwa A, van Gool C, Humphreys R, Ernst E (April 2013). "Oral evening primrose oil and borage oil for eczema". Cochrane Database Syst Rev (4): CD004416. doi:10.1002/14651858.CD004416.pub2. PMID 23633319.
  34. Koch C, Dölle S, Metzger M, Rasche C, Jungclas H, Rühl R, Renz H, Worm M (April 2008). "Docosahexaenoic acid (DHA) supplementation in atopic eczema: a randomized, double-blind, controlled trial". Br. J. Dermatol. 158 (4): 786–92. doi:10.1111/j.1365-2133.2007.08430.x. PMID 18241260.
  35. Bath-Hextall FJ, Jenkinson C, Humphreys R, Williams HC (February 2012). "Dietary supplements for established atopic eczema". Cochrane Database Syst Rev (2): CD005205. doi:10.1002/14651858.CD005205.pub3. PMID 22336810.
  36. Peroni DG, Piacentini GL, Cametti E, Chinellato I, Boner AL (May 2011). "Correlation between serum 25-hydroxyvitamin D levels and severity of atopic dermatitis in children". Br. J. Dermatol. 164 (5): 1078–82. doi:10.1111/j.1365-2133.2010.10147.x. PMID 21087229.
  37. Ong PY, Leung DY (August 2010). "The infectious aspects of atopic dermatitis". Immunol Allergy Clin North Am. 30 (3): 309–21. doi:10.1016/j.iac.2010.05.001. PMC 2913147. PMID 20670815.
  38. Huang JT, Abrams M, Tlougan B, Rademaker A, Paller AS (May 2009). "Treatment of Staphylococcus aureus colonization in atopic dermatitis decreases disease severity". Pediatrics. 123 (5): e808–14. doi:10.1542/peds.2008-2217. PMID 19403473.
  39. Lintu P, Savolainen J, Kortekangas-Savolainen O, Kalimo K (June 2001). "Systemic ketoconazole is an effective treatment of atopic dermatitis with IgE-mediated hypersensitivity to yeasts". Allergy. 56 (6): 512–7. PMID 11421895.