Atopic Dermatitis Medications Guide - Topical and Systemic

Understanding Atopic Dermatitis and Treatment Options

Atopic dermatitis (AD) is a common chronic skin condition characterized by red, intensely itchy rashes. It often first appears in infancy or childhood, but can persist into adulthood. While not curable, various atopic dermatitis medications can effectively control symptoms.

What Causes Atopic Dermatitis Flare Ups

Experts don't know exactly what causes AD, but contributing factors may include:

• Genetics
• Environmental triggers like irritants, allergens, stress, sweat, or changes in weather
• Skin barrier defects
• Immune system dysregulation

When these elements coincide, inflammatory chemicals flood the body resulting in an AD flare featuring red, cracked, oozing, intensely itchy skin.

Goals of Atopic Dermatitis Treatment

As there is no AD cure, treatment aims to:

• Heal skin to reduce redness, dryness, and thickness
• Calm inflammation and decrease flare-up frequency/severity
• Reduce urge to scratch to prevent skin damage
• Treat skin infections commonly associated with AD

Atopic dermatitis medications help achieve these goals. Lifestyle measures like avoiding triggers, using gentle skincare, and managing stress also aid control.

Types of Medications Used for Atopic Dermatitis

Many classes of prescription atopic dermatitis medications exist. Typical options include:

Topical Corticosteroids

These prescription steroid creams, ointments, gels, sprays, and foams reduce inflammation and itch. Low potency corticosteroids treat mild AD, while stronger versions treat moderate to severe cases.

Examples: hydrocortisone, triamcinolone, betamethasone

Topical Calcineurin Inhibitors

Calcineurin inhibitors like tacroliums and pimecrolimus directly lower inflammation by suppressing the immune system. They come as ointments for mild to moderate atopic dermatitis treatment.

Common brands: Protopic, Elidel

Oral Antihistamines

Allergy medications like diphenhydramine (Benadryl) and hydroxyzine relieve itching by blocking histamine receptors. Useful for occasional breakthrough itch, antihistamines rarely control AD long term alone.

Phototherapy

Using ultraviolet light rays applied to the skin under medical supervision, phototherapy calms inflammation through mechanisms still being explored. It may allow reduced reliance on medications.

Options include: UVB, UVA, UVAB, excimer laser, photochemotherapy

Systemic Immunomodulators

Powerful drugs like cyclosporine, azathioprine, methotrexate, mycophenolate mofetil and injectable biologics recalibrate the immune system to reduce attacks on the skin. Benefits continue after stopping treatment but side effects can be dangerous.

Brand names: Dupixent, Adbry (tralokinumab), Rinvoq

Antibiotics (oral and topical)

Bacterial skin infections frequently occur with AD due to scratching and a compromised skin barrier. Antibiotics treat these secondary infections to allow other atopic dermatitis medications to work better.

Anti-itch Creams

Some OTC topicals like Sarna and Soothe and Cool help override itch signalling, offer cooling sensations, or moisturize to temporarily reduce urge to scratch. Useful for spot treatment of breakthrough itch.

New and Emerging Atopic Dermatitis Treatments

Ongoing research strives to uncover new approaches to better manage AD. Recently released or still in development treatments include:

Adbry (Tralokinumab)

Just approved in 2022, Adbry is an injectable biologic designed to block signaling of IL-13, an inflammatory protein heavily involved in AD. Phase 3 trials displayed 75% skin clearance after 16 weeks.

Upadacitinib

This JAK inhibitor used orally is currently seeking FDA approval to treat moderate to severe atopic dermatitis. Studies show it significantly improves itch, redness, and skin lesions compared to placebo.

Nemolizumab

Targeting IL-31 signaling, early research indicates nemolizumab rapidly and sustainably treats intractable itching in AD patients. Larger trials are underway assessing long-term impacts.

VTP-4 Cream

VTP-4 contains antibacterial enzymes that break down S. aureus bacteria colonies aggravating skin inflammation. Early testing displays reduced AD severity and need for topical steroids.

Microbiome Therapies

Realizing skin microbiome disruption contributes to AD, scientists are investigating if probiotics, prebiotics, or fecal transplants can repair microbial balance to improve symptoms.

Photopneumatic Therapy

Using gentle bursts of energy, this emerging treatment seemingly decreases inflammation and stimulates healing factors within skin cells. Further testing into effects on AD is warranted.

Lifestyle Measures That Complement Atopic Dermatitis Medications

While prescription treatments tackle the underlying drivers of AD symptoms, certain lifestyle measures further aid control when combined with medications:

Avoid Known Triggers

Eliminating irritants like fragrances, cigarettes, pollution, laundry products with dyes or scents allows medications to work better by not continually triggering new inflammatory reactions.

Proactive Skincare Routine with Emollients

Using daily gentle cleansers and thick emollient creams/ointments forms a protective layer lessening moisture loss while enabling skin to heal and keeping out environmental aggravators.

Wet Wrap Therapy

Wet dressings covered by a dry outer layer facilitate absorption of prescription topicals for improved hydration and medication delivery to severely inflamed AD skin areas.

Stress Reduction Techniques

As emotional stress worsens AD, regularly applying stress management solutions like meditation, yoga, or cognitive behavioral therapy limits flare triggers tied to anxiety, depression, and overwhelm.

The Outlook for Controlling Atopic Dermatitis with Medications

While no definitive atopic dermatitis cure exists yet, continually emerging treatments allow most patients to effectively manage their symptoms long term.

Combining trusted topical steroids, advanced systemic drugs, targeted biologics, and phototherapy with lifestyle adjustments provides an integrative approach to reducing the physical and emotional burden of moderate to severe AD.

Disclaimer: This article is for informational purposes only and does not constitute medical advice. Always consult with a healthcare professional before starting any new treatment regimen.