Table 3.

Prescription Therapies for Atopic Dermatitis

Treatment for Mild-Moderate Atopic Dermatitis (Topical)
TherapyIndicationDosage and SchedulingSide EffectPearls
Topical corticosteroids (TCS)± Antistaphylococcal antibiotics* (fucidic acid, mupirocin, bacitracin/polymyxin B, ozenoxacin 1%)First-line prescription therapy if uncontrolled by moisturizers/irritant avoidanceMild lesions: moderate potency for 2 to 4 weeks
Acute flares: high potency for up to 2 weeks
Apply 1× to 2× daily
Steroid atrophy, purpura, telangiectasia, striae, focal hypertrichosis, acneiform or rosacea-like eruptions, allergic contact dermatitis, impairment of wound healingHigh potency TCS for areas of high absorption acceptable for 5 to 7 days before tapering
Topical calcineurin inhibitors (TCIs)Second-line treatment of mild-to-moderate atopic dermatitis in patients aged 2 years and above (aged 3 months and above for pimecrolimus)On-label dosingPotential black box warning, temporary application-site burningAvoid use on suspected eczema herpeticum; tacrolimus is also indicated for maintenance treatment to prevent flares
Topical PDE-4 inhibitorsFirst-line treatment of mild-to-moderate atopic dermatitis in patients aged 2 years and aboveOn-label dosingTransient application-site burning
Treatment for Severe Atopic Dermatitis
PhototherapyFailure of topical treatments2× to 5× weekly administrationErythema, sunburn, advanced skin-aging, itching, nauseaBurdensome and expensive
Systemic immunosuppressants (eg, methotrexate [MTX], microphenylate mofetil [MMF], and azathioprine [AZA])Failure of topical treatmentsMTX: 15 mg/week (adults)
MMF: 0.5 to 3 g/day (adult) or 40 to 50 mg/kg/day (pediatric)
AZA: 1 to 3 mg/kg/day (adult)
Gastrointestinal upset, nausea, vomiting, fatigue, hepatotoxicity, bone marrow suppression, idiopathic pulmonary fibrosis, teratogenicity, headache, leukopenia, hypersensitivity, bloating, anorexiaOrder tuberculosis test, chest radiograph, hepatitis serologies, and ensure immunizations are up to date
DupilumabFailure of topical treatments600 mg subcutaneous loading dose followed by 300 mg subcutaneous dose every 2 weeksHypersensitivity reactions, anaphylaxis, injection site reactions, conjunctivitisHigh cost, no baseline investigations or routine laboratory monitoring required
  • * Topical antistaphylococcal antibiotics should be used as an adjunct to TCS treatment in the presence of signs of mild infection concurrent with atopic dermatitis. Combination topical steroid and antibiotic creams exist.

  • Tcs, topical corticosteroids; Tci, topical calcineurin inhibitors; PDE-4, Phosphodiesterase-4 inhibitor; mtx, methotrexate; mmf, microphenylate mofetil; aza, azathioprine.