Atopic Dermatitis Treatment With Medications

By Heather Brannon, MD, About.com
Treating atopic dermatitis often requires a combination of home measures and medications, or other treatments. Because the skin in atopic dermatitis is "leaky," the foundation of treatment is improving the barrier function of the skin.
Basic Treatment of Atopic Dermatitis
Because the atopic dermatitis rash can come and go, different medications are often prescribed and used for various stages of the rash. The following are medications that may be prescribed to help manage the condition.
Topical Steroids
Topical steroids are still the first-line treatment for atopic dermatitis flares because they are effective at reducing the inflammation caused by this disease. Topical steroids come in 7 different strengths, and it is important to use the correct strength for the affected part of the body.
High-strength steroids are typically reserved for use on the arms and legs. Atopic dermatitis on the face and skin folds (armpits, groin, etc.) are usually treated with a low-strength steroid. More potent steroids are generally avoided when treating these areas, though limited and brief use -- prescribed by a dermatologist -- may help produce rapid results; patients can then be switched to a milder steroid.
Calcineurin Inhibitors
The calcineurin inhibitors are Protopic (tacrolimus) and Elidel (pimecrolimus). They are known as immunomodulators because they change some of the functions of the immune system that cause atopic dermatitis without suppressing the whole immune system. They should only be used during flare-ups.
Antihistamines
Oral antihistamines, such as Benadryl (diphenhydramine) or Atarax (hydroxyzine), can be used to treat itch associated with atopic dermatitis. It's important to note, however, that they can cause sleepiness and may not help in all cases of atopic dermatitis. Antihistamine creams should not be used on atopic dermatitis rashes because they contain chemicals that can actually worsen the rash.
Oral Antibiotics
Atopic dermatitis reduces the skin's natural defenses, making it easier for skin to become infected. If a person's atopic dermatitis is not improving as expected, this may be because the skin is infected. In this case, antibiotics are often prescribed. Antibiotics, such as Duricef(cefadroxil) or Keflex (cephalexin), are often prescribed at the first sign of infection.
Oral Steroids
Oral corticosteroids, such as prednisone, prednisolone, and medrol, may be used for more severe flares of atopic dermatitis. They are used if the rash covers a large part of the body and face. Oral steroids used long term have numerous side effects, including weight gain, thinning of the bones, and suppression of the immune system. Though they may clear atopic dermatitis well, the side effects are too risky to warrant using them as a first-line treatment. To avoid these side effects, but still benefit from the medication, oral steroids are often prescribed for a short course (5 days) to calm the rash. Topical steroids can then be used on the remaining rash.
Coal Tar
Coal tar, actually made by melting coal, has long been a treatment for a variety of skin conditions. Shampoos and soaps containing coal tar can help with mild cases of atopic dermatitis. Coal tar tends to work better on thickened skin that is not scaly, or to ease very early symptoms of itching. However, coal tar can be very irritating to already inflamed skin. It is OK to try coal tar for mild cases of atopic dermatitis, but use should stop immediately if there is any increase in itching or redness of the rash.
Leukotriene Inhibitors
Leukotriene inhibitors, such as Singulair (montelukast) or Accolate (zafirlukast), are medications that may help reduce the inflammation that leads to atopic dermatitis. These medicines are often used to treat other allergy-related diseases, such as asthma and allergic rhinitis (seasonal allergies). Though they may be recommended by some, there is currently no good data that shows that leukotriene inhibitors improve atopic dermatitis.
Other Immune-Suppressing
MedicationsMany medications are being investigated to see if they can be used to treat atopic dermatitis. Most of them are used to treat other related diseases, such as psoriasis or allergic rhinitis. These medications include:
Cyclosporine
Interferon
Methotrexate
Azothiaprine