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

Atopic dermatitis is the most common type of eczema i.e., a rash-like skin disease. It is a widespread skin concern globally but is treatable although periodic flare-ups are expected. This article will detail the different kinds of medications – topical, oral and injectable- available for treating atopic dermatitis.

*Disclaimer − Always consult a dermatologist/physician before using atopic dermatitis medications as you could have adverse reactions without proper medical guidance. Follow the dosages in the prescription precisely.

Topical Treatment for Eczema

Steroids

Corticosteroids (steroids) are the first line of topical treatment administered to reduce inflammation, rashes and redness, fissures, and bumps associated with eczema. They also alleviate itchiness, dryness, and flaky and peeling skin.

Topical steroids can be available in any strength. For example, they could be available as lotions, creams, gels, or ointments, for which the ointments will be stronger than creams.

Depending on the severity of your eczema, you will be given medications with differing levels of potency -measured in terms of the percentage of the active ingredient in the formulation that will yield the desired effect.

For example, Class 7 steroids have the least strength and they include 0.5-1% hydrocortisone creams or sprays, whereas slightly stronger but mild steroids form part of Class 6 and include 0.05% alclometasone dipropionate cream or desonide foam, for instance.

On the other end of the spectrum, Class 2 medications include 0.25% desoximetasone, 0.01 percent fluocinonide ointment whereas Class 1 topical applications like 0.05% clobetasol propionate and 0.05% halobetasol propionate are extremely powerful.

You may face side effects such as headaches, blurry vision, edema in your ankles and feet, fatigue, stretch marks, weight loss, ocular disease like cataracts and/or glaucoma, kidney malfunction, skin thinning and discoloration, acne, folliculitis, spider veins.

These side effects are rare and mostly occur after prolonged use, but if you face them refer to a doctor immediately and cease using the medications.

Topical Calcineurin Inhibitors (TCIs)

These non-steroidal alternatives to corticosteroids are anti-inflammatory agents that absorb into the skin and block immune system overactivity that causes eczema. They may be prescribed if the steroids haven’t been useful or aren’t tolerated well, or if eczema occurs in delicate areas like your face, eyelids, genitals, and neck.

TCIs aren’t more or less effective than steroids, but they may suit certain situations better, for example in the case of infants above 2 years of age. Side effects include localized irritation, stinging, itching, and erythema i.e., blood capillary inflammation upon first application. These effects are mostly temporary, abating with regular use.

Reports on the possibility of TCIs raising the risk of lymphoma remain inconclusive and unproven, but the warnings on the packaging remain.

PDE4 Inhibitors

Crisaborole i.e., Eucrisa is part of the PDE4 inhibitor class of drugs approved by the United States Food and Drug Administration (F.D.A.). It is another topical substitute that inhibits the function of the phosphodiesterase 4 enzyme responsible for inflammation. There might be pain or a stinging sensation on the application site and/or hypersensitivity.

JAK Inhibitors

Ruxolitinib is a topical medication approved by the FDA, that works by inhibiting cytokines i.e., cell-signalling proteins associated with inflammation.

It can be used for short-term, intermittent treatment for mild cases, and isn’t recommended for severe cases and for people at risk of developing blood clots.

There have been cases of carcinomas in people treated with this medication, although a clear link has not been scientifically established.

The other two latest JAK inhibitors namely upadacitinib and abrocitinib are FDA approved for oral administration in moderate to severe cases, but they shouldn’t be used in conjunction with any other immunosuppressants/ JAK inhibitors/ biologics.

These medications could have life-threatening side effects including heart attacks, strokes, and fatal infections – warnings are mentioned on the packaging.

Systemic Medications for Atopic Dermatitis

Immunosuppressants are one category of systemic drugs that can be taken orally or administered via injections. These include cyclosporine, mycophenolate mofetil, and azathioprine, although these aren’t FDA approved for atopic dermatitis.

They are being used “off-label” i.e., for a purpose other than their primary therapeutic intent, but can only be used provisionally as they pose serious side effects such as kidney or liver damage, heightened blood pressure, and are potentially carcinogenic.

The second category of systematic medications is biologic drugs that block the activity of interleukins- cytokines secreted mainly by white blood cells in response to pathogens. These are activated unnecessarily by the immune system even when there are no pathogens to fight off leading to conditions like eczema.

The two biologics approved for use by the FDA are Dupilumab and Tralokinumab-ldrm, to be injected over the treatment period. They may cause issues like conjunctivitis, eye/eyelid swelling, cold sores on the mouth, and high amounts of eosinophilia white blood cells

Alternative Therapies/ Home Remedies for Atopic Dermatitis

Doctors will prescribe antihistamines for hives/rashes or sleep aids to help people with atopic dermatitis have restful sleep without itching. They may also provide wet dressings in which a wet gauze is used to seal in steroid cream, and bound by dry gauze.

If topical and other treatments fail to prevent recurrent flare-ups, phototherapy i.e., light therapy is attempted in which the affected areas of skin are exposed to natural sunlight, artificial UVA or UVB rays for a controlled period of time and in controlled amounts.

Phototherapy can cause pigmentation, premature ageing, and possibly different forms of skin cancers, so infants and children shouldn’t be administered this phototherapy.

Conclusion

You can take care of atopic dermatitis at home by using self-care techniques such as bathing twice a day in warm water using a non-irritating cleanser without added colour, fragrance and alcohol, wearing loose, airy clothing, using humidifiers at home to hydrate parched skin, and moisturizing your skin using a dermatologist recommended product.

You can also add colloidal oatmeal to your bath water and soak in it for about 10 minutes before patting dry, or soak in a diluted bleach bath as per your doctor’s advice.

To prevent stress-related flare-ups seek counselling so you learn relaxation techniques and modify behaviours such as scratching.