Atopic dermatitis is a type of eczema, though the terms are sometimes used interchangeably. It can be treated with over-the-counter and prescription products that you apply to your skin, as well as with phototherapy.
Atopic dermatitis (AD) is a chronic skin condition characterized by dry skin and a persistent rash. AD is a type of eczema — other types of eczema include contact dermatitis, seborrheic dermatitis, and more.
Atopic dermatitis affects close to 16.5 million U.S. adults.
Finding a good prevention and treatment plan for AD is essential for managing symptoms. Untreated AD will continue to itch and lead to more scratching. Once you start scratching affected areas, you have a greater risk of infection.
Effective treatment can help you maintain a higher quality of life and get better sleep. Both are essential for reducing stress, which can lead to increased flare-ups.
While there currently isn’t a cure for AD, there are different treatment options. These include over-the-counter (OTC) products, prescription medications, and phototherapy.
Many treatment options for AD are available without a prescription.
Moisturizers
Moisturizing the skin is one of the simplest and most effective AD treatments. To relieve dry skin caused by AD, you must add moisture to the affected skin.
The best way to do this is to apply a moisturizer immediately after bathing while the skin is still damp.
OTC moisturizers are a good long-term treatment solution. There are three different types of moisturizers: lotions, creams, and ointments.
Lotions
Lotions are the lightest moisturizers. Lotions are a mix of water and oil that you can easily spread over your skin.
But the water in lotion evaporates quickly, so it may not be the best choice for severe AD.
Creams
A cream is a semisolid mixture of oil and water. The oil content is higher in cream than in lotion. Creams are more emollient than lotion, meaning they better hydrate the skin.
Creams are a great daily moisturizing option for chronically dry skin.
Ointments
Ointments are semisolid greases with very high oil content and much less water than lotions and creams.
Ointments are very moisturizing and should only have a few ingredients. The simplest ointment is petroleum jelly, which only has one ingredient.
Having very few ingredients makes ointments a good option for those with sensitive skin. But because these formulations feel greasy on the skin, it might be best to apply them before bed.
Topical steroids
For short-term treatments, low potency topical corticosteroids are available over the counter. Low strength hydrocortisone creams (such as Cortaid or Nutracort) are available at most drugstores and grocery stores.
You can apply hydrocortisone immediately after you moisturize your skin. It’s most effective for treating a flare-up.
The American Academy of Dermatology Association (AAD) generally recommends treating the affected area twice daily. Topical corticosteroids are not for long-term use. Instead, the AAD recommends occasional preventive use.
Talk with a doctor about the possibility of using hydrocortisone 1–2 times per week in areas prone to flare-ups.
Oral antihistamines
According to the AAD, OTC oral antihistamines can supplement the topical treatment of AD.
Antihistamines aren’t generally recommended as a stand-alone treatment. But antihistamines like diphenhydramine (Benadryl) can help manage the itch-scratch cycle. The slight sedative effect may also help if your itching keeps you awake at night.
If you’re still experiencing flares despite OTC options, your doctor might write you a prescription. There are different types of prescription medications and topicals used to treat AD.
Prescription topical steroids
Most topical steroids are available only by prescription. Topical steroids are grouped by potency, ranging from class 1 (strongest) to class 7 (least potent).
Most of the strongest, more potent topical steroids aren’t suitable for children, so always consult with your child’s doctor first.
Topical steroids may be prepared as lotions, creams, or ointments that are applied to the skin.
Like moisturizers, ointments might be the best option if creams tend to cause burning or stinging.
Topical calcineurin inhibitors
Topical calcineurin inhibitors (TCIs) are a relatively new class of anti-inflammatory drugs. They do not contain steroids. Yet they’re effective in treating the rash and itching caused by AD.
In 2006, the Food and Drug Administration (FDA) added a black box warning label to the packaging of these two medications. The warning alerts consumers of a possible link between TCIs and cancer.
There are two prescription TCIs on the market today: pimecrolimus (Elidel) and tacrolimus (Protopic).
The FDA admits that it will take decades of research to determine whether there’s an actual proven cancer risk. In the meantime, the FDA recommends that these medications only be used as second-line treatment options.
If your doctor determines that your AD isn’t responding to other treatments, they may consider short-term treatment with TCIs.
Injectable anti-inflammatories
Dupilumab (Dupixent), which was
Oral medications
Topical prescriptions are the most common treatment for AD. On occasion, a doctor may prescribe oral medications such as:
- oral corticosteroids for widespread, severe, and resistant AD
- cyclosporine or interferon for severe AD
- antibiotics if you develop a bacterial skin infection
- certain janus kinase (JAK) inhibitors
Phototherapy refers to treatment with light. Treatment with narrowband ultraviolet B (NB-UVB) light is the most common form of phototherapy for people with AD.
Treatment with NB-UVB eliminates the skin-damaging risks of ultraviolet A (UVA) light from sun exposure.
Phototherapy is a good second-line option if you aren’t responding to more standard treatment. It can also be used for maintenance treatment.
Cost and accessibility are two of the biggest cons of phototherapy. You would need access to phototherapy treatment 2–3 times per week. This may require significant travel time and cost.
Even with treatment, you may still experience AD flares from time to time. But there are things you can do to help reduce your discomfort:
- Moisturize: Do this after bathing and whenever your skin feels dry. According to the AAD, creams give better hydration than lotions. Choose fragrance-free options.
- Do a patch test: Always test any new skin product on a small patch of skin before using it on more of your skin, just in case it aggravates your symptoms or you develop an allergic reaction.
- Short baths: Keep your baths or showers short and use warm water, then apply the moisturizer while your skin is still damp.
- Avoid triggers: Identify your triggers for eczema flare-ups and avoid them. This may include things like dust, dry air, pollen, and sunburn.
- Wear loose clothing: Choose clothes made of cotton and remove tags before wearing them.
- Protect your skin outdoors: Take care of your skin by covering up in cold weather, staying cool in hot weather, and always wearing sunscreen outside.
What is the first line of treatment for atopic dermatitis?
The first choice for treating AD is usually topical corticosteroids, sometimes in combination with TCIs like pimecrolimus and tacrolimus.
What clears up atopic dermatitis?
AD cannot currently be cured, though symptoms can sometimes improve over time, especially if the condition develops in childhood. Treatment can help manage the symptoms.
What is the strongest over-the-counter (OTC) steroid cream for eczema?
The strongest OTC cream for eczema is 1% hydrocortisone cream.
With all of these treatment options, you can be optimistic that you will find a way to manage your symptoms.
Talk with a doctor about creating the best AD treatment plan for you. If your doctor writes you a new prescription, make sure to ask questions about proper use.