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Treatment of atopic eczema

Finding the treatment that's right for you

There are many different treatments available for atopic dermatitis (AD). Whether you have AD yourself or care for someone who does, you may have encountered some of them already. But evidence suggests that 3 out of 5 people with moderate-to-severe AD are poorly managed, which means you, or the person you care for, might not be receiving the best-suited treatment.1

Below, we'll talk through the different types of treatments there are for AD. That way, you've got the knowledge to confidently discuss them with a dermatologist and get one step closer to long-term control.

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Topical treatment

Topical treatments are applied directly onto the skin's surface to manage the signs and symptoms of AD,2-4 and can be used alongside other treatments or on their own.5 These include emollients, topical corticosteroids and topical calcineurin inhibitors.

While basic emollients and moisturisers form the foundation of topical treatment, topical corticosteroids and topical calcineurin inhibitors are usually the first anti-inflammatory treatments that can be prescribed for AD.5,6

Emollients and moisturisers are creams that you apply directly onto the skin. They protect against moisture loss by providing a barrier that traps in water.2 This limits itchy, dry skin and reduces the risk of infection.2

  • They can be applied regularly and generously throughout the day to hydrate the skin2.7
  • They help to ease symptoms such as dry, itchy, or scaly skin7
  • You may use emollients alongside other treatments for skin conditions2.5
  • You should be able to pick up emollients and moisturisers at your local supermarket or pharmacy

Topical corticosteroids come in different forms, including creams and ointments.3 They are applied onto the skin to reduce the inflammation and irritation associated with AD.3

  • They have been used for over 60 years to reduce the severity of damaged skin, inflammation, and itching for adults and children 3,8
  • They're available on prescription, and in different strengths depending on the severity of AD3,8
  • They're typically applied directly onto the affected area9
  • The most common side effect is a small burning sensation when applying the medicine.3 However, this usually improves once the skin gets used to the treatment3

If the skin isn't hydrated enough, or the AD rashes are weeping, a doctor may recommend using a wet wrap before applying topical corticosteroids.6.8

This method uses two types of dressings. The first dressing is moistened with warm water and then wrapped around the affected area. The second dressing is left dry and wrapped around the first (e.g. a pyjama top).8

Talk to a doctor about how to prepare these before using the treatment.

Topical calcineurin inhibitors are non-steroidal medicines.10 They target the immune system to interfere with the production of the chemicals that contribute to AD.10

  • They're available as an ointment or cream that is applied directly to the skin4
  • They can be applied to all parts of the body, including the neck and genitals, where topical corticosteroids may not be suitable4.6
  • Tingling or burning is a common side effect that can last about an hour, but the intensity and duration of this typically disappears within a few days of use4.6.11
  • If you're using topical calcineurin inhibitors, it's recommended to minimise exposure to sunlight and use sunscreen and when going out into the sun to help protect the skin against ultraviolet (UV) damage. Speak to your doctor to find out more

Treatments beyond topicals

If topical treatments alone aren't enough to manage the signs and symptoms of AD, a dermatologist may prescribe a treatment beyond topicals to help you achieve better control of the condition.5 This could be phototherapy, a biologic agent (biologic), a JAK inhibitor or an immunosuppressant, depending on factors such as age and the severity of AD.5

While phototherapy uses waves of light on the skin, other treatments beyond topicals work from within the body to reduce the inflammation associated with AD.5,12 They are either taken as a pill or an injection.5

Phototherapy uses different wavelengths of artificial UV light to help reduce the itch and inflammation related to AD.12,13

  • It's mainly used to treat the itchiness associated with AD6
  • It's usually performed by a healthcare professional and may require regular trips to the clinic. 13 The length of treatment can vary depending on the individual condition 12, 13
  • The most common side effects include sunburn and skin tenderness12

Biologic agents (also known as biologics) used to treat AD are proteins that target specific parts of the immune system, called interleukins, to reduce the underlying inflammation associated with the signs and symptoms of AD.5,14

  • Your dermatologist may prescribe this treatment for someone with AD 6 months of age or older, when topicals alone aren't effectively controlling the condition5,15
  • They're given as an injection to stop the medicine from being broken down in the stomach16-18
  • Biologic agents can be used alone or in conjunction with topical treatments5
  • Possible side effects of biologics include nose, sinus or throat infections, joint pain, and conjunctivitis5

Taken orally, Janus kinase (JAK) inhibitors reduce the activity of JAK enzymes in the immune system to decrease the inflammation associated with the signs and symptoms of AD.5

  • They may be prescribed from 12 years of age or older when topical treatments alone aren't effective at controlling AD5
  • They can sometimes be used in conjunction with topical treatments5
  • Possible side effects of JAK inhibitors include nose, sinus or throat infections, increased "bad" cholesterol, nausea and stomach pain, acne and headaches5
  • Starting and staying on JAK inhibitors requires regular blood tests and other examinations to monitor for any changes during treatment, including to blood count, the liver and kidneys

Immunosuppressants broadly inhibit or prevent activity in the immune system to reduce the inflammation associated with the signs and symptoms of AD.19

  • They're taken orally or injected for the treatment of AD, suppressing the immune system to help reduce signs and symptoms 5,19
  • They're generally taken for a short period of time before switching to other medications for long-term management19
  • There are many different immunosuppressant treatments with varying treatment plans and side effects for each drugs • Oral corticosteroids are a type of immunosuppressant that is only prescribed reactively to control a flare, as using them for more than a month may lead to serious side effects19
  • Starting and staying on immunosuppressants requires regular blood tests and other examinations to monitor for any potential changes during treatment to the blood, liver, and kidneys5

Finding the treatment that's right for you

There are many different treatments available for atopic dermatitis (AD). Whether you have AD yourself or care for someone who does, you may have encountered some of them already. But evidence suggests that 3 out of 5 people with moderate-to-severe AD are poorly managed, which means you, or the person you care for, might not be receiving the best-suited treatment.1

Below, we'll talk through the different types of treatments there are for AD. That way, you've got the knowledge to confidently discuss them with a dermatologist and get one step closer to long-term control.


AD is different for everyone, and that goes for managing it too. A dermatologist will often take many things into consideration when deciding which approach will work best for you. That's why it's important to give them as much information as possible about your experience with AD, whether you have AD or care for someone else who does.

So, if a treatment isn't working or if AD is getting out of hand, don't wait. Talk to a dermatologist about ways to achieve long-term control.

Symptoms

Lets take an in-depth look at the signs and symptoms of AD. Learn how they appear on adults and children, and on different skin tones.

Find out more

Managing AD

Feeling like you've tried everything to manage your AD7 Don't lose hope. We've got the tips, tools and information you need to get closer to control.

Go to Managing AD

  1. Wei W et al. J Dermatol 2018; 45: 150-157.
  2. National Eczema Society. Emollients factsheet. Available at: https://eczema.org/wp-content/uploads/Emollients-Oct-18-1.pdf. Accessed April 2023.
  3. NHS. Topical corticosteroids. Available at: https://www.nhs.uk/conditions/topical-steroids/. Accessed April 2023.
  4. National Eczema Association. Prescription topicals. Available at: https://nationaleczema.org/eczema/treatment/topicals/. Accessed April 2023.
  5. Wollenberg A et al. J Eur Acad Dermatol Venereol 2022; 36: 1409-1431.
  6. Wollenberg A et al. J Eur Acad Dermatol Venereol 2022; 36: 1904-1926.
  7. NHS. Emollients. Available at: https://www.nhs.uk/conditions/emollients/. Accessed April 2023.
  8. Eichenfield LF et al. J Am Acad Dermatol 2014; 71: 116-132.
  9. National Eczema Association. Tips for using topical corticosteroids. Available at: https://nationaleczema.org/tips-for-using-topical-corticosteroids/. Accessed April 2023.
  10. Rady Children's Hospital San Diego. Topical calcineurin inhibitors. Available at: https://www.rchsd.org/programs-services/dermatology/eczema-and-inflammatory-skin-disease-center/treatment/topical-calcineurin- inhibitors/. Accessed April 2023.
  11. Baldo A et al. Clin Cosmet Investig Dermatol 2009; 2: 1-7.
  12. National Eczema Association. Prescription phototherapy. Available at: https://nationaleczema.org/eczema/treatment/phototherapy/. Accessed April 2023.
  13. National Eczema Society. Phototherapy. Available at: https://eczema.org/wp-content/uploads/Phototherapy-Nov-22.pdf. Accessed April 2023.
  14. Worm M et al. J Dtsch Dermatol Ges 2020; 18(10): 1085–1092.
  15. Butala A and Paller AS. J Allergy Clin Immunol 2023; 151: 681-5.
  16. New R. Pharmaceutics 2021; 13(1): 1–21.
  17. Boguniewicz M et al. Ann Allergy Asthma Immunol 2018; 120(1): 10-22.
  18. Wollenberg A et al. Br J Dermatol 2021; 184: 437-449.
  19. National Eczema Association. Prescription oral. Available at: https://nationaleczema.org/eczema/treatment/immunosuppressants/. Accessed April 2023.