title: Treatment of Eczema: Corticosteroids and Beyond.
abstract: Atopic dermatitis (AD) is a chronic inflammatory skin condition that requires a manifold approach to therapy. The goal of therapy is to restore the function of the epidermal barrier and to reduce skin inflammation. This can be achieved with skin moisturization and topical anti-inflammatory agents, such as topical corticosteroids and calcineurin inhibitors. Furthermore, proactive therapy with twice weekly use of both topical corticosteroids and calcineurin inhibitors in previously affected areas has been found to reduce the time to the next eczematous flare. Adjunctive treatment options include wet wrap therapy, anti-histamines, and vitamin D supplementation. Bacterial colonization, in particular Staphylococcus aureus, can contribute to eczematous flares and overt infection. Use of systemic antibiotics in infected lesions is warranted; however, empiric antibiotics use in uninfected lesions is controversial. Local antiseptic measures (i.e., bleach baths) and topical antimicrobial therapies can be considered in patients with high bacterial colonization. Difficult-to-treat AD is a complex clinical problem that may require re-evaluation of the initial diagnosis of AD, especially if the onset of disease occurs in adulthood. It may also necessitate evaluation for contact, food, and inhaled allergens that may exacerbate the underlying AD. There are a host of systemic therapies that have been successful in patients with difficult-to-treat AD, however, these agents are limited by their side effect profiles. Lastly, with further insight into the pathophysiology of AD, new biological agents have been investigated with promising results.
authors: Rheumatology, Allergy & Immunology, Winthrop University Hospital, 120 Mineola Blvd, Suite 410, Mineola, NY, 11501, USA. melanie.hj.chong@gmail.com.
authors: Melanie
authors: http://orcid.org/0000-0002-4439-2670
authors: M
authors: Chong
authors: Rheumatology, Allergy & Immunology, Winthrop University Hospital, 120 Mineola Blvd, Suite 410, Mineola, NY, 11501, USA.
authors: Luz
authors: L
authors: Fonacier
mesh_terms: D000305:Adrenal Cortex Hormones / Q000008:administration & dosage / Q000627:therapeutic use*; D000890:Anti-Infective Agents / Q000008:administration & dosage / Q000627:therapeutic use; D065095:Calcineurin Inhibitors / Q000008:administration & dosage / Q000627:therapeutic use; D003131:Combined Modality Therapy; D003876:Dermatitis, Atopic / Q000175:diagnosis / Q000628:therapy; D003877:Dermatitis, Contact / Q000175:diagnosis / Q000628:therapy; D003888:Desensitization, Immunologic; D019468:Disease Management; D004485:Eczema / Q000175:diagnosis / Q000209:etiology / Q000378:metabolism / Q000628:therapy*; D004817:Epidermis / Q000187:drug effects / Q000276:immunology / Q000473:pathology; D006633:Histamine Antagonists / Q000008:administration & dosage / Q000627:therapeutic use; D006801:Humans; D007166:Immunosuppressive Agents / Q000008:administration & dosage / Q000627:therapeutic use; D010789:Phototherapy / Q000379:methods
chemical_list: D000305:Adrenal Cortex Hormones; D000890:Anti-Infective Agents; D065095:Calcineurin Inhibitors; D006633:Histamine Antagonists; D007166:Immunosuppressive Agents
keywords: Atopic dermatitis; Contact dermatitis; Difficult-to-treat atopic dermatitis; Topical calcineurin inhibitors; Topical corticosteroids