Topical corticosteroids are commonly used to calm the irritation from an eczema or atopic dermatitis flare. These anti-inflammatory medications are available in various strengths, with “super potent” being the strongest. The more potent, the greater the risk of side effects.
Mild or acute cases of atopic dermatitis usually respond well to mild corticsteroids. Severe or chronic atopic dermatitis, with skin thickening, or on the palms or soles, may require more potent corticosteroids.
If topical corticosteroids are used for too long or inappropriately, they can cause side effects such as thinning of the skin, or become absorbed into the blood.
Use only mild corticosteroids on delicate areas like the face, groin, underarms, and genitals. Potent formulations should only be used for a few weeks at a time and never on wounds or skin that is thinned from overuse. Potent corticosteroids should be used with special care in children.
In general, moderate-to-potent corticosteroids are recommended for use on thick lesions for a limited time.
Calcineurin Inhibitors (Elidel, Protopic)
Calcineurin inhibitors (TCIs), also called “topical immunomodulators”, are a type of medication applied to the skin that can help control the symptoms of atopic dermatitis and reduce the need for topical corticosteroids. They are a useful alternative for sensitive locations, such as the face and skin folds. They are generally effective and well tolerated.
There are currently two FDA-approved topical immunomodulators for treating atopic dermatitis: Elidel (pimecrolimus) and Protopic (tacrolimus). Both work by reducing inflammation and other symptoms of atopic dermatitis. These medicines have fewer side effects than topical corticosteroids, but it has been theorized that they may lead to an increase risk of skin cancer.
Antihistamines (Benadryl, Atarax)
Oral antihistamines help reduce the itching and scratching of eczema that can further damage the skin. They are often recommended for use at night to help prevent scratching during sleep, and some people find them too sedating for use during the day.
Bacteria, such as staph, can live on the surface of skin without causing any problems. However, at times, these bacteria can trigger atopic dermatitis flare-ups or prevent inflamed skin from healing.
Topical antibiotics are useful because they can be applied directly to an inflamed area. However, an oral antibiotic, such as cephalexin or erythromycin, may be recommended if larger areas are inflamed or appear infected,
Short courses of oral corticosteroids, such as prednisone, may help control a severe case quickly. Risks of this treatment include a rebound of symptoms and side effects such as dizziness or fatigue. The medication is usually limited to a few weeks and the dosage is often tapered off.
When atopic dermatitis fails to respond to any other therapies, immunosuppressive drugs may be recommended to calm the immune system. These include cyclosporine, methotrexate, azathioprine, and mycophenolate (Cellcept).