Allergic Dermatitis (Atopic Dermatitis)

Allergic Dermatitis (Atopic Dermatitis) – Treatment Overview

Introduction
Allergic dermatitis, commonly referred to as atopic dermatitis (AD), is a chronic, relapsing inflammatory skin condition characterized by itching, redness, and eczematous lesions. It often arises from a combination of genetic predisposition, immune dysregulation, and environmental triggers. The management aims to relieve symptoms, reduce inflammation, prevent flare-ups, and maintain skin hydration. Treatment depends on the severity of the condition and is tailored to each patient.

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Treatment Options and Doses

1. Emollients and Moisturizers

• Role: First-line therapy for all patients. They restore skin barrier function, reduce dryness, and prevent flare-ups.

• Usage: Liberal application multiple times daily, especially after bathing. No fixed dose, but frequent use is recommended.

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2. Topical Corticosteroids

• Mild cases:

  • Hydrocortisone 1% cream/ointment: Apply thinly once or twice daily.

• Moderate to severe cases:

  • Betamethasone valerate 0.1% or Mometasone furoate 0.1%: Apply once daily for up to 2–4 weeks.

• Note: Use the lowest potency needed. Long-term use should be avoided on the face and flexures.

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3. Topical Calcineurin Inhibitors (for steroid-sensitive areas)

• Tacrolimus ointment 0.03% (children) or 0.1% (adults): Apply twice daily to affected areas.

• Pimecrolimus cream 1%: Apply twice daily.

• Useful for long-term maintenance and areas like face/eyelids.

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4. Antihistamines (for pruritus relief)

• Cetirizine: 10 mg orally once daily.

• Loratadine: 10 mg orally once daily.

• Sedating antihistamines (e.g., hydroxyzine 25 mg at night) may help with sleep disturbance due to itching.

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5. Systemic Corticosteroids (short-term, severe flares)

• Prednisolone: 0.5–1 mg/kg/day orally for 5–7 days, then taper.

• Not recommended for long-term use due to adverse effects.

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6. Immunosuppressants (for refractory cases)

• Cyclosporine: 3–5 mg/kg/day orally, divided into two doses.

• Methotrexate: 7.5–25 mg once weekly (with folic acid supplementation).

• Azathioprine: 1–3 mg/kg/day orally.

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7. Biologic Therapy (for moderate–severe atopic dermatitis unresponsive to conventional therapy)

• Dupilumab (IL-4 receptor antagonist):

  • Adults: 600 mg subcutaneously as initial dose, then 300 mg every 2 weeks.

  • Adolescents/children (≥6 years): Dosing adjusted by weight.

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8. Supportive Measures

• Avoid triggers (harsh soaps, allergens, irritants).

• Use gentle, fragrance-free cleansers.

• Keep nails short to minimize skin damage from scratching.

• Wet wrap therapy may be useful in severe flares.