Monday, November 4, 2019

What treatments are - and aren't - effective for atopic dermatitis?

- Jennifer Middleton, MD, MPH

Atopic dermatitis, or eczema, is quite prevalent in the United States, and its aggravating itching can significantly disrupt quality of life. Several studies in recent years have explored a range of alternative and additive therapies to treat atopic dermatitis. While some of these therapies have demonstrated potential, some have not; meanwhile, the evidence supporting the benefit of more traditional treatments continues to grow.

Cochrane for Clinicians in the November 1 issue of AFP casts doubt on one proposed therapy, reviewing a meta-analysis that found minimal benefit, if any, of oral antihistamines compared to typical topical treatments for improving eczema symptoms. Another recent Cochrane review found that probiotics did not help patients with eczema. One of the "Top POEMs of 2018 Consistent with the Principles of the Choosing Wisely Campaign" found bath oil ineffective for children with eczema.

Regarding effective treatments, however, other recent Cochrane reviews have affirmed the benefit of topical emollients as well as topical corticosteroids and UV light therapy. Another effective option for children and adults with moderate to severe eczema is topical tacrolimus, as reviewed in this AFP Cochrane for Clinicians article. An article on "Complimentary and Alternative Therapies for Atopic Dermatitis" describes small randomized controlled trials supporting the use of both evening primose oil and homeopathy, although additional, larger studies would help to confirm these findings.

The American Academy of Dermatology, as reviewed in this AFP Practice Guideline, further reinforces the importance of moisturizing regularly with products free of fragrance or other sensitizing ingredients. This guideline discusses indications for topical corticosteroids and topical calcineurin inhibitors (such as tacrolimus or pimecrolimus). The 2012 AFP "Atopic Dermatitis: An Overview" reviews diagnosis and classification along with commonly used medications and when to consider referral to a dermatologist. If you'd like to read more, the AFP By Topic on Skin Conditions' subheading on Dermatitis contains several additional resources.