Medication Summary
Short-term treatment may include high-potency topical corticosteroids, such as clobetasol propionate, to decrease inflammation. Topical tacrolimus 1% ointment may be a good long-term choice. Oral antihistamines may be administered if severe pruritus ensues. [27]
Corticosteroids, Topical
Class Summary
Corticosteroids are immunosuppressives with anti-inflammatory properties that modify the body's immune response to diverse stimuli. Other actions include vasoconstriction and antiproliferation. These agents have limited use in the treatment of protein contact dermatitis.
Clobetasol propionate (Temovate, Clobex, Cormax)
A class I superpotent topical steroid, clobetasol suppresses mitosis and increases synthesis of proteins that decrease inflammation and cause vasoconstriction. This agent decreases inflammation by stabilizing lysosomal membranes, inhibiting polymorphonuclear leukocyte and mast cell degranulation.
Immunomodulators, Topical
Class Summary
These agents modify immune processes that promote inflammation.
Tacrolimus (Protopic, Prograf)
The mechanism of action of tacrolimus in atopic dermatitis not known. Reduces itching and inflammation by suppressing release of cytokines from T cells. It also inhibits transcription for genes that encode interleukin (IL)–3, IL-4, IL-5, granulocyte-macrophage colony-stimulating factor (GM-CSF), and tumor necrosis factor–alpha, all of which are involved in early stages of T-cell activation.
Additionally, tacrolimus may inhibit release of preformed mediators from skin mast cells and basophils and may down-regulate expression of high-affinity IgE receptor (FCeRI) on Langerhans cells.
Tacrolimus can be used in patients as young as 2 years. It is more expensive than topical corticosteroids. This agent is available as an ointment in concentrations of 0.03% and 0.1%. It is indicated only after other treatment options have failed.
Antihistamines
Class Summary
Antihistamines act by competitive inhibition of histamine at the H1 receptor. They may control itching by blocking effects of endogenously released histamine.
Hydroxyzine hydrochloride (Vistaril)
This agent antagonizes H1 receptors in the periphery. It may suppress histamine activity in the subcortical region of the central nervous system.
