12 Atopic Dermatitis Treatments Dermatologists Rely On to Manage the Chronic Skin Condition
Atopic dermatitis—a chronic inflammatory skin condition, and the most common type of eczema—affects more than 9.6 million children and 16.5 million adults in the US alone, according to the National Eczema Association (NEA).
There's no cure for atopic dermatitis—but that doesn't mean those who live with it are destined to suffer from dry, itchy, discolored skin forever. In fact, there are quite a few options dermatologists use to help treat the chronic skin condition by managing symptoms and reducing the time between flare-ups.
In general, treatment options for atopic dermatitis can be broken down into three categories: prescription medications, targeted therapies, and home remedies or lifestyle changes. Here, dermatologists break down what you need to know about each type of treatment for atopic dermatitis.
Medications for atopic dermatitis
Prescription or over-the-counter (OTC) oral or topical medications are typically the first line of defense against atopic dermatitis.
Topical corticosteroids—or steroids, for short—are considered the "mainstay" of treatment for atopic dermatitis, Dendy Engelman, MD, FAAD, a board-certified dermatologist, tells Health. These anti-inflammatory medications—available either OTC or in prescription form, are applied directly to the skin to help reduce redness and itchiness until symptoms go away. Steroids can be incredibly effective to combat eczema flare-ups, but if used long-term without breaks or medical supervision, they can cause side effects like stretch marks, skin thinning, and perioral dermatitis (an itchy rash around your mouth). Typically, topical steroids for eczema require a prescription, although OTC hydrocortisone can also be used for milder cases, according to the NEA
Topical non-steroidal anti-inflammatories
These drugs are often used to treat eczema on thin skin (say around the eyes or on the face) instead of steroids, David Kim, MD, a board-certified cosmetic dermatologist, tells Health. That's because thinner skin absorbs more of the steroid, and thus increases your risk of side effects. Doctors also give these drugs to patients who have had lots of side effects with topical steroids, or to people who have been on steroids for over a month without much improvement in symptoms. These drugs also work to reduce itchiness and inflammation, but aren't as powerful as topical steroids. Examples include Elidel (pimecrolimus) and Protopic (tacrolimus), which effectively turn off the immune response that causes itchiness and redness. Eucrisa (crisaborole) is another non-steroidal topical that inhibits an inflammatory enzyme called phosphodiesterase-4.
These are often used along with topical treatments to help "control the itch," Tiffany Jow Libby, MD, director of Mohs micrographic and dermatologic surgery at Brown Dermatology, tells Health. She says she'd have a patient try Zyrtec or Allegra during the day and then Benadryl at night in order to help further soothe their itch. However, the American Academy of Dermatology (AAD) says there's not a ton of evidence to support their general use for treating atopic dermatitis—and shouldn't be used in place of other proven treatments like steroids and other topicals.
This is a very, very new topical treatment option—the FDA granted approval for the drug in September 2021, according to a press release from parent company Incyte. Opzelura (ruxolitinib) is a JAK (janus kinase) inhibitor, meaning that it inhibits a specific pathway that makes immune cells produce inflammatory proteins.
These types of drugs have been used before to treat other inflammatory conditions like rheumatoid arthritis. In this case, the drug is meant to help non-immunocompromised patients with moderate-to-severe atopic dermatitis who haven't responded to other treatments, according to the press release.
Immunosuppressants do exactly what the same suggests—they suppress a person's immune response. When they're used for atopic dermatitis, the drugs help to reduce symptoms and flare ups.
One example of an immunosuppressant used to help manage atopic dermatitis is the oral medication cyclosporine, says Dr. Libby. It's a very strong drug that is typically reserved for extensive, resistant disease, she says. Other types of immunosuppressants include mycophenolate mofetil and azathioprine, which are normally used for organ transplant patients and to manage certain chronic diseases, but are sometimes prescribed off-label for very severe eczema.
Like topical steroids, oral steroids work to combat inflammation, thus calming flare-ups of atopic dermatitis. Unlike topicals, oral steroids are systemic, meaning they work through the entire body and not just the affected area. They are very strong and typically reserved to treat extremely severe flare-ups. The AAD recommends that they be used sparingly, as symptoms can relapse (and worsen) once treatment ends.
Therapies for atopic dermatitis
While prescription treatments are the most common way to treat eczema and manage its symptoms. But there are some in-office therapies that can be effective for stubborn or severe cases of atopic dermatitis:
Dupixent (dupilumab) is a biologic therapy approved by the FDA for those with severe eczema that does not respond to topical prescriptions or for patients who cannot use topical prescriptions, per the NEA. "It's an injectable biologic that helps to reboot the immune system to minimize the signs and symptoms of eczema over time," Dr. Engelman says. Specifically, this treatment uses human monoclonal antibodies to combat the immune response that causes eczema. It's very effective, Dr. Engelman says, but requires shots every two weeks and isn't always covered by insurance.
This is a secondary eczema treatment often used for people with eczema all over their bodies, or who haven't responded to topical medications, the NEA says. Targeted UV light is applied to the skin to help gradually decrease skin inflammation and reduce symptoms. It's considered safe for adults and children with serious eczema, but can come with some side effects (like sunburn and skin discoloration), the AAD reports. It also requires multiple treatments per week for a few months, which can be expensive and hard for people to keep up with.
Home remedies and lifestyle changes for atopic dermatitis
To be clear: Your first stop for atopic dermatitis treatment should be with a dermatologist. The best, most effective treatments are prescription medications, and should be taken under the supervision of a doctor to ensure that you don't have reactions to the meds or that the treatments are actually working.
That said, there are some things you can do at home to reduce the risk of triggering a flare up, or to soothe your skin while you're treating particularly annoying symptoms:
Atopic dermatitis weakens your skin barrier, making it more vulnerable to dryness, irritation, and infection. Moisturize immediately after washing your hands, says Dr. Kim, and after showering or bathing. You should opt for a product that has no fragrances or artificial colors, he says, as those ingredients can be irritating to eczema-prone skin. Look for ingredients like ceramides, Dr. Libby adds, because these naturally fortify the skin barrier to keep moisture in.
These can induce a flare up or make it worse, and vary depending on the person. Common ones include fabrics like wool, environmental allergens like dust mites and pollen, fragrances, and specific food allergies, according to the NEA. Stress is another common eczema trigger, says Dr. Engelman.
Simplify your skin care routine
People with atopic dermatitis have very sensitive, reactive skin, so you're going to want to lay off the trendy acid toners and at-home peeling masks and stick with very gentle, mild cleansers and moisturizers. Avoid harsh active ingredients, adds Dr. Engelman, such as alpha-hydroxy acids (AHAs) like glycolic or lactic acid, beta-hydroxy acids (BHAs) like salicylic acid, and retinols. (Read your labels carefully!) If you're also looking to fight acne or address signs of skin aging, talk to your dermatologist to come up with a routine your skin can handle.
Try a diluted bleach bath—carefully
Hear us out on this one: Bleach bathes are actually a recognized treatment for adults and children with eczema on large areas of their body, per the AAD.
Basically, you soak for a few minutes in a bathtub filled with water and a tiny amount of regular strength bleach (not the concentrated stuff). The amount of bleach used varies depending on the age of the person taking a bath, and how much water is being used, but the AAD recommends half a cup of bleach for a full bathtub of water; or for children, one teaspoon of bleach for each gallon of water. This remedy can reduce redness, itchiness, and skin scaling. "It not only helps treat but also increases the time between your flare-ups," says Dr. Libby, who recommends this treatment to her patients. Talk with your dermatologist before trying it to ensure you're doing it safely.
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