Atopic dermatitis
- Moisturizer + trigger/skin-barrier care are foundational
- Topical corticosteroid for active flares
- Tacrolimus/pimecrolimus for steroid-sparing sensitive sites
- Moderate–severe disease → biologic or oral targeted therapy
- Dupilumab is a major first biologic option
- Treat superinfection but avoid routine antibiotics
Use at a glance
- Moisturizer + trigger/skin-barrier care are foundational
Treatment options
- Topical corticosteroid for active flares
- Tacrolimus/pimecrolimus for steroid-sparing sensitive sites
- Dupilumab is a major first biologic option
Other treatment options
- Moderate–severe disease → biologic or oral targeted therapy
Safety / pitfalls
- Treat superinfection but avoid routine antibiotics
Key points
- Bathe/shower → immediate emollient for hydration
- 1st-line TCS; medium/high potency initially, medium-potency 2–3×/wk maintenance
- TCIs (tacrolimus, pimecrolimus): no atrophy; OK face, intertriginous, maintenance
- Topical PDE4i (crisaborole, roflumilast): modest efficacy, well tolerated
- Tapinarof (topical AhR) short-term moderate–severe; topical ruxolitinib (JAKi) ≤20% BSA, non-continuous
- Topicals fail → narrowband UVB phototherapy
- Moderate–severe refractory: SC dupilumab/tralokinumab/lebrikizumab/nemolizumab; oral abrocitinib/upadacitinib after other systemics, serious AEs
Nonpharmacologic therapies
- Skin hydration
- Emollients
- Narrowband UVB phototherapy
- Home UVB phototherapy
- Allergen-specific immunotherapy
- Probiotics
Pearls
- Oral antihistamines don't treat AD itch
- Probiotics don't improve established AD
- Oral steroids: short courses only, for severe flares
- Avoid prolonged eyelid steroids: glaucoma, cataracts
- Narrowband UVB safe in pregnancy and breastfeeding
Self-check
- Which agents spare steroids at sensitive atopic-dermatitis sites?
Tacrolimus/pimecrolimus. - What treats moderate–severe atopic dermatitis?
Biologic or oral targeted therapy.
Drugs used for this (21)
All clinical uses · Open Atopic dermatitis in the interactive console ↗