General considerations

Topical corticosteroids are the main treatment for atopic dermatitis in all age groups. They should be used in addition to general measures such as improving the skin condition and avoiding aggravating factors. Nonsteroid–based topical treatments (eg topical pimecrolimus, tar preparations, crisaborole) are considered in some patients—see here for more information.

Treat all areas of inflammation aggressively until the skin is completely clear (particularly in infants and young children, to avoid a chronic cycle of inflammation). It usually takes 7 to 14 days for the skin to completely clear, but can take less time in mild cases, or more time in severe cases or on thicker skin. Recurrence is more common when the inflammation is undertreated. Apply the topical corticosteroid to all areas of inflammation, not just the worst. Ensure adequate quantities of topical corticosteroids are prescribed; authority from the Pharmaceutical Benefits Scheme (PBS) is required to prescribe larger quantities of corticosteroids¹.

Misplaced fear about the safety of topical corticosteroids is the most common reason for underuse and therapy failure. Reassure patients, parents and carers that the harms of poorly controlled atopic dermatitis outweigh the harms of topical corticosteroids.

For more information on application quantities of and safety considerations with topical corticosteroids, see Considerations in the use of topical corticosteroids.

Choice of treatment differs depending on severity and the body part being treated. An ointment base is more effective than a cream base because atopic dermatitis tends to be dry. An ointment base also typically stings less. A cream base may be used for an acute weeping rash, and lotions or hydrogels are appropriate for hairy areas.