Atopic Dermatitis Treatment Plan

Goals for treating atopic dermatitis

1. Reduce inflammation (“put out the fire”) as quickly as possible. Use topical corticsteroids as recommended by your doctor. Topical corticosteroids are safe when used appropriately and are the fastest way to bring a flare under control. Go back to your maintenance routine once the flare subsides.

2. Provide safe, long-term skin stability.

  • Apply moisturizers frequently and liberally.
  • Apply corticosteroids, Elidel® or Protopic® on a schedule prescribed by your doctor.

Bathing Do’s and Don'ts

Bathing can be good for the skin. Errors in bathing and moisturizing are the most common cause of persistent atopic dermatitis. Bathing can dry the skin when it evaporates, leaving small cracks in the outer dry skin barrier and resulting in rough and scaling skin. However, bathing hydrates and softens the skin, IF a moisturizer is applied within 3 minutes of getting out of the water.

  • Soaking the skin in water before applying moisturizers enhances the effectiveness of the moisturizer.
  • Corticosteroids penetrate 5-10 times better into hydrated skin.
  • Bathing cleanses infected, crusted areas.
  • Bathing is easier than using wet compresses for atopic dermatitis.
  • Bathing can be relaxing and enjoyable.
  • Avoid very hot water. Lukewarm water is always best
  • Avoid vigorous scrubbing with washcloths or rubbing with towels.
  • Soap and Cleansers: Mild cleansers without fragrances are best. Others may be okay, if skin is well rinsed and promptly moisturized.
  • Bubble baths with fragrances can be irritating for atopic dermatitis.
  • Stay in the shower or bathtub until fingertips are wrinkled. This is a sign that maximum skin hydration has been achieved. This may take 5-20 minutes.

Atopic dermatitis treatment options

Therapies that have been studied and shown to be effective:

  • Topical corticosteroids
  • Calcineurin inhibitors (Protopic®, Elidel®)
  • Ultraviolet light
  • Cyclosporin

Therapies that are used by some people, but not yet shown to be effective:

  • Specialized diets
  • Herbal medicines or supplements, such as borage or primrose oil
  • Acupuncture

Topical corticosteroids for atopic dermatitis

What Patients / Parents Need to Know

  • This category of medication, "glucocorticosteroids", is applied to the skin to reduce inflammation. It is not related to the  "anabolic steroids" are used by body builders.
  • Topical corticosteroids are the most effective and often the only anti-inflammatory medications that can quickly bring acute flares under control.
  • Topical medications are preferable to oral medications or injections.
  • There are varying potencies (strengths) of corticosteroids. The potency used must be adequate and proportional to the severity of the flare.
  • The goal is to use corticosteroids briefly and effectively.

Calcineurin inhibitors (Protopic® & Elidel®)

Tacrolimus (Protopic®) Ointment

  • Approved for moderate to severe atopic dermatitis
  • 0.1% strength available for those over 15 years of age
  • 0.03% concentration available for those 2-15 years of age

Pimecrolimus (Elidel®) 1% cream

  • For mild to moderate atopic dermatitis.
  • For used in those 2 years of age and older.

Comparison of Medications

Corticosteroids (hydrocortisone, desonide, others)

  • Range of potencies
  • Rapid effect
  • Daily long-term use is unsafe
  • Risk of side effects when used on face, eyes, or groin
  • Best when applied after bath

Calcineurin Inhibitors (Protopic® / Elidel®)

  • Less potent
  • Less rapid effect
  • Safer for long-term use
  • Safe for use on face, eyes, or groin
  • Flares benefit from initial use of corticosteroids.

Review provided by Jon Hanifin, M.D., courtesy of Oregon Health Sciences University.

This information is for general educational uses only. It may not apply to you and your personal medical needs. This information should not be used in place of a visit, call, consultation with or the advice of your physician or health care professional.

Communicate promptly with your physician or other health care professional with any health-related questions or concerns.

Be sure to follow specific instructions given to you by your physician or health care professional.

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