Atopic dermatitis, also known as atopic eczema, is a chronic skin condition that affects millions of people worldwide, causing persistent itching, dry patches, and inflamed skin that can significantly impact daily life and emotional wellbeing.

Understanding Treatment Goals for Atopic Dermatitis

When someone is diagnosed with atopic dermatitis, the journey toward managing this condition begins with understanding that while there is currently no cure, effective treatments exist to control symptoms and improve quality of life. The main goals of treatment focus on relieving the intense itching that characterizes this condition, repairing and protecting the skin barrier, reducing inflammation, and preventing flare-ups from occurring or becoming severe.^[1]

Treatment approaches for atopic dermatitis are highly individualized because the condition manifests differently in each person. What works well for one patient may not be as effective for another. The severity of the condition plays a crucial role in determining which treatments are appropriate. Some people experience mild symptoms with occasional flare-ups, while others struggle with moderate to severe atopic dermatitis that covers large areas of the body and requires more intensive management.^[2]

Healthcare providers typically follow clinical guidelines established by medical societies when developing treatment plans. These guidelines are based on years of research and clinical experience, helping doctors choose the most appropriate therapies. The treatment plan usually combines several approaches, including regular skin care routines, medications applied to the skin, and in more severe cases, systemic treatments that work throughout the body.^[3]

An important aspect of atopic dermatitis management is the ongoing nature of care. Because this is a chronic condition with a tendency to flare up periodically, treatment isn’t just about addressing symptoms when they appear, but also about maintaining the health of the skin between flare-ups. This preventive approach, called maintenance therapy, has become an essential component of modern atopic dermatitis treatment strategies.^[11]

Beyond the standard treatments that have been used for years, medical research continues to advance our understanding of atopic dermatitis. Scientists are actively investigating new therapies through clinical trials, exploring innovative approaches that target specific pathways involved in the disease process. These research efforts offer hope for patients whose condition hasn’t responded well to traditional treatments, potentially providing more options in the future.^[16]

Standard Treatment Approaches

Moisturizers and Emollients: The Foundation of Care

The cornerstone of atopic dermatitis treatment is the regular and liberal use of moisturizers, also called emollients. These products work by creating a protective layer on the skin that helps lock in moisture and prevents water loss. When the skin is well-hydrated, it functions better as a barrier against irritants and allergens, and it feels less itchy and uncomfortable.^[3]

Moisturizers should be applied at least twice daily, and ideally more frequently when the skin feels dry. The timing of application matters significantly. Applying moisturizer immediately after bathing, when the skin is still slightly damp, helps trap water in the skin. Healthcare providers often recommend thick, fragrance-free moisturizers or ointments like petroleum jelly or specific emollient creams designed for sensitive skin. These products are generally safer than lotions, which may contain ingredients that could irritate already inflamed skin.^[13]

Some patients find that their symptoms improve with daily bathing using lukewarm water for short periods, typically five to ten minutes, followed immediately by moisturizing. However, it’s essential to avoid hot water and harsh soaps, as these can strip away the skin’s natural oils and worsen dryness. Instead, gentle, soap-free cleansers are recommended.^[4]

Topical Corticosteroids: Managing Inflammation

When moisturizers alone aren’t enough to control symptoms, topical corticosteroids become the first-line medication treatment. These are anti-inflammatory creams, ointments, or gels that are applied directly to affected areas of skin. They work by reducing inflammation, which in turn decreases redness, swelling, and itching. Corticosteroids have been used successfully for decades and remain one of the most effective treatments for atopic dermatitis flare-ups.^[13]

Topical corticosteroids come in various strengths, from mild to very potent, and the choice depends on several factors including the severity of the condition, the location on the body, and the patient’s age. Milder corticosteroids are typically used on sensitive areas like the face, eyelids, and skin folds, while stronger preparations may be needed for thicker skin on the body or for more severe inflammation. Healthcare providers carefully select the appropriate strength to balance effectiveness with the need to minimize potential side effects.^[11]

The standard application schedule is once daily, although twice-daily application was historically common. Research has shown that applying these medications once per day is generally as effective as more frequent application, which is encouraging for patients trying to maintain a manageable treatment routine. Once the flare-up improves, the medication is typically tapered off gradually rather than stopped abruptly.^[3]

For patients with recurrent moderate to severe atopic dermatitis, a maintenance regimen using topical corticosteroids applied a few times per week to previously affected areas may help reduce the frequency of flare-ups. This proactive approach represents a shift from only treating active symptoms to preventing them from developing in the first place.^[3]

Topical Calcineurin Inhibitors: An Alternative Anti-inflammatory Option

For situations where topical corticosteroids may not be ideal—such as treatment of sensitive facial skin or when there’s concern about skin thinning from prolonged corticosteroid use—topical calcineurin inhibitors offer an alternative. The two medications in this class are tacrolimus and pimecrolimus, which work by suppressing certain immune system activities that contribute to skin inflammation.^[11]

These medications are recommended as second-line treatment for moderate to severe atopic dermatitis, particularly for people over two years of age. They can be especially useful for treating areas where skin is thin and more vulnerable to the side effects of corticosteroids, such as around the eyes, on the face, and in body folds. Unlike corticosteroids, calcineurin inhibitors don’t cause skin thinning, making them suitable for longer-term use in certain situations.^[3]

The US Food and Drug Administration issued a boxed warning about a theoretical risk of skin cancer and lymphoma associated with these medications. However, extensive studies conducted since then have not demonstrated a clear link between topical calcineurin inhibitor use and these conditions. Healthcare providers weigh the benefits against potential risks when recommending these treatments.^[3]

Managing Secondary Infections

People with atopic dermatitis have skin that is more vulnerable to infections, particularly from Staphylococcus aureus bacteria. When skin becomes infected, it may appear more inflamed, develop crusts or pus-filled spots, feel warm to the touch, or begin weeping clear or yellowish fluid. These signs require prompt treatment with antibiotics.^[4]

Topical antibiotics may be prescribed for localized skin infections, while oral antibiotics are necessary for more widespread or severe bacterial infections. However, research has shown that using antibiotics preventively—when there’s no clear evidence of infection—is not effective in reducing atopic dermatitis flare-ups and may contribute to antibiotic resistance. Therefore, antibiotics should only be used when there’s actual evidence of infection.^[3]

Some healthcare providers recommend dilute bleach baths as an adjunctive treatment to reduce bacterial colonization on the skin. This involves adding a small amount of household bleach to bathwater, creating a solution similar to the chlorine concentration in a swimming pool. When used as directed, this approach may help some patients with recurrent skin infections.^[14]

Phototherapy for Moderate to Severe Cases

When topical treatments don’t adequately control moderate to severe atopic dermatitis, phototherapy (also called light therapy) may be considered. This treatment involves exposing the skin to controlled amounts of ultraviolet light under medical supervision. The most commonly used form is narrowband UVB phototherapy, which has anti-inflammatory effects on the skin.^[13]

Phototherapy typically requires visiting a healthcare facility two to three times per week for several weeks or months. While it can be very effective for widespread atopic dermatitis, it’s generally not the first choice for children due to concerns about long-term sun exposure risks. The treatment must be carefully monitored by healthcare professionals who can adjust the light exposure based on how the skin responds.^[3]

Systemic Immunosuppressants

For severe atopic dermatitis that hasn’t responded to other treatments, systemic medications that work throughout the body may be necessary. Traditional immunosuppressant drugs like cyclosporine, methotrexate, azathioprine, and mycophenolate mofetil have been used to manage severe cases. These medications suppress the overactive immune response that contributes to atopic dermatitis.^[14]

Cyclosporine is particularly effective for treating severe or refractory atopic dermatitis and may provide relatively quick improvement. However, because these immunosuppressant medications can have significant side effects and require regular monitoring through blood tests, they are reserved for cases where other treatments have failed. They’re typically used for limited periods rather than as long-term solutions.^[3]

Oral corticosteroids (steroid pills) may occasionally be prescribed for very severe flare-ups, but they’re not recommended for long-term management. While they can provide rapid relief, stopping them can lead to a rebound worsening of symptoms, and prolonged use carries risks of serious side effects throughout the body.^[14]

Treatment Options in Clinical Trials

The landscape of atopic dermatitis treatment has been transformed in recent years by groundbreaking research that has led to the development of targeted therapies. These newer treatments work by interfering with specific molecules or pathways involved in the inflammatory process that drives atopic dermatitis, rather than broadly suppressing the immune system.^[16]

Biologic Therapies: Targeting Specific Immune Pathways

One of the most significant advances in atopic dermatitis treatment has been the approval of dupilumab, a biologic medication that targets specific proteins called interleukin-4 and interleukin-13. These proteins play key roles in the type of inflammation seen in atopic dermatitis. By blocking their action, dupilumab can reduce inflammation and improve skin symptoms.^[11]

Dupilumab is administered as an injection under the skin, typically every two weeks after an initial loading dose. It has been approved for moderate to severe atopic dermatitis in adults and children who haven’t responded adequately to topical treatments. Clinical trials have shown that this medication can significantly reduce itch and improve skin appearance, with many patients experiencing substantial improvement in their quality of life.^[16]

Another biologic medication being tested in clinical trials is tralokinumab, which specifically targets interleukin-13. Like dupilumab, this medication is given as an injection and has shown promise in clinical studies for reducing the signs and symptoms of moderate to severe atopic dermatitis. The research has demonstrated that blocking interleukin-13 alone can be effective in controlling the inflammatory process.^[14]

Lebrikizumab is another interleukin-13 inhibitor that has been evaluated in clinical trials for atopic dermatitis. Studies have explored its effectiveness when used alone or in combination with topical corticosteroids, with results suggesting it can improve skin clearance and reduce itching in patients with moderate to severe disease.^[14]

JAK Inhibitors: Oral and Topical Options

A particularly exciting area of research involves medications called Janus kinase (JAK) inhibitors. These drugs block enzymes that are part of the signaling pathway used by multiple inflammatory molecules. By interrupting these signals, JAK inhibitors can reduce inflammation and the associated symptoms of atopic dermatitis.^[18]

Upadacitinib is an oral JAK inhibitor that has been approved for moderate to severe atopic dermatitis in patients who haven’t responded well to other systemic therapies. It’s taken as a pill once daily, which many patients find more convenient than injections. Clinical trials have shown that upadacitinib can provide rapid improvement in itching—often within days—and significant skin clearance over time.^[14]

Baricitinib is another oral JAK inhibitor that has demonstrated effectiveness in treating moderate to severe atopic dermatitis in clinical studies. Like upadacitinib, it works by blocking the JAK enzymes involved in inflammatory signaling pathways. Research has shown improvements in both skin appearance and itch intensity among patients taking this medication.^[14]

Abrocitinib represents yet another oral JAK inhibitor that has been studied in Phase III clinical trials for atopic dermatitis. These advanced-phase trials compare the new medication against placebo (inactive treatment) or standard therapies to definitively establish whether it’s safe and effective. Studies of abrocitinib have shown promising results in reducing disease severity and improving patients’ quality of life.^[14]

Topical Innovations

Beyond systemic treatments, researchers have also developed new topical medications with novel mechanisms of action. Crisaborole is a topical phosphodiesterase-4 (PDE-4) inhibitor that works by reducing inflammation in the skin through a different pathway than corticosteroids or calcineurin inhibitors. It’s applied twice daily as an ointment and has been approved for mild to moderate atopic dermatitis in patients two years and older.^[13]

A topical JAK inhibitor called delgocitinib has been studied for treating atopic dermatitis. This medication offers the targeted benefits of JAK inhibition without the systemic exposure that comes with oral JAK inhibitors. Clinical research has evaluated its safety and effectiveness when applied directly to affected skin areas.^[18]

Another innovative topical approach involves aryl hydrocarbon receptor (AhR) agonists, which work by activating receptors that help restore the skin barrier and reduce inflammation. These represent a completely different mechanism from traditional atopic dermatitis treatments and are being investigated in clinical trials.^[18]

Understanding Clinical Trial Phases and Participation

Clinical trials for atopic dermatitis treatments are conducted in medical centers and research facilities around the world, including locations in the United States, Europe, and other regions. Patients interested in participating must typically meet specific criteria, such as having moderate to severe disease that hasn’t adequately responded to standard treatments, being within certain age ranges, and not having certain other medical conditions that might interfere with the study.^[16]

Preliminary results from many of these trials have been encouraging. For example, studies of biologic therapies have shown that substantial numbers of patients achieve significant skin clearance—meaning a large reduction in the extent and severity of their rash. Improvements in itch scores have also been documented, with some patients reporting that this most bothersome symptom becomes much more manageable. Safety profiles have generally been acceptable, though all medications have potential side effects that researchers monitor carefully throughout the trial process.^[16]

Most Common Treatment Methods

• Skin Barrier Repair and Maintenance
  • Regular application of moisturizers and emollients at least twice daily to hydrate skin and maintain the protective barrier
  • Daily bathing with lukewarm water and soap-free cleansers for short periods, followed immediately by moisturizing
  • Use of thick, fragrance-free products such as petroleum jelly or specialized emollient creams
  • Avoidance of hot water, harsh soaps, and known irritants that can damage the skin barrier
• Topical Anti-inflammatory Treatments
  • Topical corticosteroids in varying strengths as first-line treatment for flare-ups, typically applied once daily
  • Topical calcineurin inhibitors (tacrolimus and pimecrolimus) as second-line options, particularly for sensitive areas like the face
  • Maintenance therapy with topical medications applied a few times weekly to prevent recurrent flare-ups
  • Crisaborole, a topical phosphodiesterase-4 inhibitor, for mild to moderate disease
• Systemic Therapies for Moderate to Severe Disease
  • Dupilumab, a biologic injection targeting interleukin-4 and interleukin-13, administered every two weeks
  • Oral JAK inhibitors including upadacitinib, baricitinib, and abrocitinib taken daily as pills
  • Traditional immunosuppressants such as cyclosporine, methotrexate, azathioprine, and mycophenolate mofetil for refractory cases
  • Short courses of oral corticosteroids for severe acute flare-ups only, not for long-term use
• Phototherapy
  • Narrowband ultraviolet B (UVB) light therapy administered two to three times weekly under medical supervision
  • Used for moderate to severe atopic dermatitis when topical treatments are insufficient
  • Requires multiple visits to healthcare facilities over weeks to months
• Infection Management
  • Topical or oral antibiotics when secondary bacterial infections are present, indicated by increased inflammation, crusting, or weeping
  • Dilute bleach baths to reduce bacterial colonization in patients with recurrent skin infections
  • Antibiotics not used preventively without evidence of active infection
• Emerging Treatments in Clinical Trials
  • Additional biologic therapies targeting interleukin-13, including tralokinumab and lebrikizumab
  • Topical JAK inhibitors such as delgocitinib providing targeted inflammation control
  • Aryl hydrocarbon receptor agonists representing novel mechanisms for barrier repair and inflammation reduction