Medication Summary
The basis of treatment for atopic dermatitis is to provide moisturization for dryness, allay pruritus, and manage inflammation of the eczematous lesions.
Anti-inflammatory agents
Class Summary
Provide relief of inflammation of eczematous lesions. Ointment base provides moisturization. White petrolatum is useful to avoid potential sensitization to preservatives in water-based moisturizers.
Hydrocortisone ointment 1% (Cortaid)
Mild topical corticosteroid mixed in petrolatum. Has mineralocorticoid and glucocorticoid effects and anti-inflammatory activity.
Use 1% ointment 2-3 times daily.
Betamethasone topical (Beta-Val)
Medium-strength topical corticosteroid for body areas. Decreases inflammation by suppressing migration of polymorphonuclear leukocytes and reversing capillary permeability. Affects production of lymphokines and has inhibitory effect on Langerhans cells.
Use 0.05-0.1% ointment in adults and 0.05% ointment in pediatrics.
Antihistamines
Class Summary
Provide symptomatic relief of pruritus.
Hydroxyzine hydrochloride (Atarax)
Antihistamine with antipruritic, anxiolytic, and mild sedative effects. Antagonizes H1 receptors in periphery. May suppress histamine activity in subcortical region of CNS.
Syr available as 10 mg/5 mL.
Diphenhydramine (Benadryl)
Antihistamine used for pruritus and allergic reactions.
Immunomodulators
Class Summary
For treatment of patients with severe disease in whom conventional therapy is ineffective. In more severe cases and particularly in adults, consider using both MTX and cyclosporine. The latter is more efficacious, but lesions recur when it is stopped.
Cyclosporine (Neoral, Sandimmune)
Demonstrated to be helpful in a variety of skin disorders, especially psoriasis. Acts by inhibiting T-cell production of cytokines and ILs. Like tacrolimus and pimecrolimus (ascomycin), cyclosporine binds to macrophilin and then inhibits calcineurin, a calcium-dependent enzyme, which, in turn, inhibits phosphorylation of nuclear factor of activated T cells and inhibits transcription of cytokines, particularly IL-4. Discontinue treatment if no response within 6 wk.
Methotrexate (Folex PFS, Rheumatrex)
Antimetabolite that inhibits dihydrofolate reductase, thereby hindering DNA synthesis and cell reproduction. Satisfactory response seen 3-6 wk following administration.
Adjust dose gradually to attain satisfactory response.
Tacrolimus (Protopic) ointment 0.03% or 0.1%
Immunomodulator that suppresses humoral immunity (T-lymphocyte) activity. Used for refractory disease.
Antiviral agents
Class Summary
For management of herpetic infections and to treat atopic dermatitis in patients who develop chickenpox.
Acyclovir (Zovirax)
Inhibits activity of both HSV-1 and HSV-2. Has affinity for viral thymidine kinase and, once phosphorylated, causes DNA-chain termination when acted on by DNA polymerase. Patients experience less pain and faster resolution of cutaneous lesions when used within 48 h of rash onset. May prevent recurrent outbreaks. Early initiation of therapy is imperative. Zoster dose is 4 times higher than that for herpes simplex. Duration of therapy varies.
Antibiotics
Class Summary
Empiric antimicrobial therapy must be comprehensive and should cover all likely pathogens in the context of the clinical setting. For the treatment of clinical infection by S aureus, cloxacillin or cephalexin is used. In streptococcal infections, cephalexin is preferred. If not effective, penicillin and clindamycin in combination are effective. Consider staphylococcal infection in every flare of atopic dermatitis.
Cephalexin (Keflex)
First-generation cephalosporin arrests bacterial growth by inhibiting bacterial cell wall synthesis. Bactericidal activity against rapidly growing organisms. Primary activity against skin flora; used for skin infections or prophylaxis in minor procedures.
Available susp include mauve granules (125 mg/5 mL) and peach granules (250 mg/5 mL).
Cloxacillin (Cloxapen, Tegopen)
For treatment of infections caused by penicillinase-producing staphylococci. May be used to initiate therapy when a staphylococcal infection is suspected.
Penicillin VK (Beepen-VK, Betapen-VK, Veetids)
Inhibits biosynthesis of cell wall mucopeptide. Bactericidal against sensitive organisms when adequate concentrations are reached, and most effective during stage of active multiplication. Inadequate concentrations may produce only bacteriostatic effects.
Clindamycin (Cleocin)
Lincosamide for treatment of serious skin and soft tissue staphylococcal infections. Also effective against aerobic and anaerobic streptococci (except enterococci). Inhibits bacterial growth, possibly by blocking dissociation of peptidyl t-RNA from ribosomes, causing RNA-dependent protein synthesis to arrest.
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