Summary of management in atopic dermatitis

To manage atopic dermatitis:

• advise patients to improve the skin condition (eg by frequently applying emollients)van Zuuren, 2017
• identify and avoid aggravating factors
• treat areas of inflammation with topical corticosteroids with or without modified dressings—oral corticosteroids are rarely appropriate because rebound flare can occur when they are stoppedDrucker, 2018Yu, 2018. Nonsteroid–based topical treatments (eg topical pimecrolimus, tar preparations, crisaborole) are considered in some patients; see here for more information
• treat infections, if present.

Effective treatment restores normal function of the epidermal barrier, which provides protection from the environment; this is particularly important in infants, because sensitisation to food and environmental allergens may occur through the affected skin.

In adults and older children with disturbed sleep from itching, sedating antihistamines can help (see here for doses of sedating antihistamines). Less-sedating antihistamines are not useful for itch unless the patient also has allergic rhinitis (hayfever) or urticaria.

If the patient does not respond to treatment, or if atopic dermatitis is frequently recurring or severe, referral to a dermatologist may be required. See also Lack of response to treatment for dermatitis. Specialist treatments include narrowband ultraviolet B phototherapy (in conjunction with usual topical therapy), oral immunosuppressants (eg ciclosporin, azathioprine, methotrexate), biological therapy (eg dupilumab) and Janus kinase (JAK) inhibitors (eg upadacitinib). Admission to hospital is occasionally required for severe atopic dermatitis for intense topical therapy with wet dressings.

Fish oil or evening primrose oil supplements are not beneficial. The benefit of using probiotics in infants and young children is uncertain.