Relieving the discomfort of atopic dermatitis, the most common form of eczema, can be a daily task. This inflamed, itchy skin condition can interfere with sleep, social interaction, and many other activities.
If home remedies like gentle cleansing and regular moisturizing don't relieve symptoms, your doctor may recommend prescription skin treatments. Which prescription cream is most effective? A new study boils it down to a few overall winners.
What is atopic dermatitis and the scratch-scratch cycle?
Atopic dermatitis is a chronic inflammatory skin disease. Commonly affected areas include the folds of skin on the face, hands, feet, elbows, or behind the knees.
We don't know the exact cause of atopic dermatitis. Genes, environment and an overactive immune system all appear to play a role in producing the inflammation that makes people feel itchy. Scratching the itchy area creates more irritation and inflammation, leading to more itching.
As the itching-scratch cycle continues, the rash can become more severe. The skin may tear, ooze, and crust over, which can be painful.
Which skin treatments were more effective in the study?
Some prescription topical skin treatments for atopic dermatitis are more effective than others, according to 2023 research published online in the Journal of Allergy and Clinical Immunology .
The scientists evaluated more than 200 randomized trials involving more than 43,000 people with atopic dermatitis (average age 18 years). Researchers compared nearly 70 different prescription ointments or ointments, which are broadly known as topical treatments and are designed to be applied to affected areas of skin.
These treatments are divided into five categories . If you have eczema, you may or may not be familiar with their common names, but your healthcare team may be familiar with them:
- Topical corticosteroids , divided into seven categories from strongest to weakest, reduce the release of an inflammatory chemical called phospholipase A2
- Topical Janus kinase (JAK) inhibitors interrupt inflammatory signals as they enter cells
- Topical PDE4 inhibitors increase the production of a chemical called phosphodiesterase 4, or PDE4, and reduce the body's inflammatory response
- Topical calcineurin inhibitors help inhibit the production of chemical messengers that tell the body to build up its defenses
- Other topical treatments include antibiotics and prescription moisturizers.
Which drug results are important to patients:
- Improve quality of life
- Can reduce the severity, itching, sleep disturbance or eczema flare-ups associated with eczema
- Causes the fewest serious side effects
- Discontinuation was least common due to serious side effects.
Which atopic dermatitis medication has been shown to be the most effective?
- Two calcineurin inhibitors: pimecrolimus (Elidel) and tacrolimus (Protopic)
- A broad category of moderately potent topical corticosteroids includes fluocinolone acetonide (Synalar cream 0.025%) and triamcinolone acetonide (Kenalog cream/ointment 0.1%).
What do these drugs improve?
- Pimecrolimus improved six of the seven outcomes and came out on top for reducing sleep disturbances and eczema flare-ups.
- High-dose tacrolimus (0.1%) improved five outcomes and was best at reducing itching and eczema flare-ups.
- Moderately potent steroids improved four to six of the seven outcomes and were most effective at reducing eczema itching, redness, and severe side effects.
In studies, the strongest topical steroids appeared to be the most effective at reducing eczema severity. However, for long-term maintenance, we may consider switching to a moderately potent steroid or one of the non-steroid options to minimize the risk of eczema skin thinning, which can occur with long-term use of topical steroids.
Studies have found that applying a topical cream twice a day has little effect compared to using a topical cream once a day. The traditional recommendation is twice a day, once a day is more convenient to use and can help people stick to their medication regimen without reducing efficacy.
Topical antibiotics are one of the least effective ways to treat eczema in studies.
Should you change your treatment?
While the study included more than 40,000 people, what worked for participants may not always work for you, as different people may respond differently to the same treatment, and there are many factors to consider when developing a treatment plan. , including your age, affected area of skin, severity of eczema, and potential side effects.
If a treatment regimen works for you, continue it as long as you don't have any serious side effects. If your current treatment regimen isn't working, talk to your doctor or dermatologist to see if there are other prescription creams or ointments you can try.
