Ophthalmologic Manifestations of Atopic Dermatitis Medication

Updated: Sep 07, 2016
  • Author: R Scott Lowery, MD; Chief Editor: Hampton Roy, Sr, MD  more...
  • Print
Medication

Medication Summary

The most commonly used treatment strategies include antibiotics, corticosteroids, antihistamines, and, less commonly, immunosuppressives (other than steroids), UV light, and hospitalization (rare). For most cases of atopic dermatitis (without AKC), application of topical steroids to the affected area is usually sufficient. Eye involvement may be treated with topical steroids alone, or if symptoms persist, additional mast cell stabilizers (topical), and oral antihistamines (eg, over-the-counter diphenhydramine). AKC may require all of these, and some ophthalmologists recommend that an oral antibiotic be given in addition to a topical antibiotic for the affected eye(s). Antibiotic treatment should target S aureus, the most likely pathogen, and should be chosen based on the patient's allergies and compliance. Immunosuppressives, other than steroids, will only very rarely be required, and these likely will not be prescribed by the ophthalmologist.

Next:

Corticosteroids

Class Summary

As anti-inflammatory and immunosuppressive agents, corticosteroids are beneficial in treating atopic dermatitis. Dexamethasone, fluorometholone, hydrocortisone, and prednisolone are the most commonly available preparations of ophthalmic steroids in the United States. Preparations range from 0.05-2.5%. For most topical purposes, a 0.5% preparation of prednisolone, cortisone, or hydrocortisone is adequate.

Prednisolone ophthalmic (Omnipred, Pred Forte, Pred MIld)

Based on weight, prednisolone has 3-5 times the anti-inflammatory potency of hydrocortisone. Glucocorticoids inhibit edema, fibrin deposition, capillary dilatation and proliferation, phagocytic migration of the acute inflammatory response, deposition of collagen, and scar formation.

Fluorometholone (Flarex, FML, FML Forte, FML Liquifilm)

Fluorometholone inhibits edema, fibrin deposition, capillary dilatation, and phagocytic migration of acute inflammatory response and capillary proliferation, collagen deposition, and scar formation. Used topically, this agent can elevate intraocular pressure (IOP) and cause steroid-response glaucoma. However, in clinical studies of documented steroid responders, fluorometholone demonstrated a significantly longer average time to produce a rise in IOP than dexamethasone phosphate. In a small percentage of individuals, a significant rise in IOP occurred within 1 week. The ultimate magnitude of the rise was equivalent.

Previous
Next:

Mast cell stabilizers

Class Summary

May be useful as prophylaxis against exacerbation of the disease.

Lodoxamide (Alomide)

Inhibits degranulation of mast cells and helps prevent histamine release.

Cromolyn

Inhibits histamine and slow-releasing substance of anaphylaxis (SRS-A) release from mast cells but has no intrinsic anti-inflammatory, antihistamine, or vasoconstrictive effects.

Nedocromil ophthalmic (Alocril)

Nedocromil interferes with mast cell degranulation, specifically with release of leukotrienes and platelet activating factor.

Previous
Next:

Oral antihistamines

Class Summary

Useful in decreasing itching and scratching associated with atopic dermatitis.

Hydroxyzine (Vistaril)

Antagonizes H1 receptors in periphery; may suppress histamine activity in subcortical region of CNS; may assist in sleep.

Diphenhydramine (Benadryl, Benadryl Dye-Free Allergy, Complete Allergy Relief, Q-Dryl, Diphen)

Diphenhydramine is for symptomatic relief of urticaria symptoms caused by the release of histamine in allergic reactions.

Loratadine (Alavert, Allergy Relief, Claritin, Loratadamed)

Loratadine selectively inhibits peripheral histamine H1 receptors.

Desloratadine (Clarinex)

Desloratadine is a long-acting tricyclic histamine antagonist that is selective for H1 receptors. This agent is a major metabolite of loratadine, which, after ingestion, is extensively metabolized to active metabolite 3-hydroxydesloratadine.

Fexofenadine (Allegra Allergy, Allegra Allergy 24 Hour, Mucinex Allergy)

Fexofenadine competes with histamine for H1 receptors in the GI tract, blood vessels, and the respiratory tract, reducing hypersensitivity reactions.

Previous
Next:

Antibiotics, Ophthalmic

Class Summary

Atopic conjunctivitis requires the use of topical antibiotics that particularly target S aureus, the most common pathogen. Since most ophthalmic antibiotics will target this bacterium, physician discretion, reference to package inserts, and the ophthalmic Physicians' Desk Reference are recommended. Patients' allergies and compliance should be considered.

Gatifloxacin ophthalmic (Zymaxid)

Fluoroquinolone with activity against streptococci, staphylococci, Corynebacterium propinquum, and Haemophilus influenzae; inhibits bacterial DNA synthesis and, consequently, growth.

Previous