What Are the Treatments for Atopic Dermatitis for Adults?
Atopic dermatitis (AD), also known as eczema, affects close to 1 in 10 adults. It’s common in younger people, too. Atopic dermatitis is a chronic condition you may have struggled with all your life. So if you’re having a hard time with atopic dermatitis and its symptoms, you’re surely not alone. While your symptoms may appear limited to the skin, the intense cycle of itching, scratching, and rash also can have serious implications for your ability to enjoy life. When left untreated or poorly controlled, atopic dermatitis also can lead to complications, including problems with depression, sleep, concentration, infections, and more.
Some basic and familiar steps you can take at home to help with the discomfort of atopic dermatitis and its flares include:
- Cold compresses or ice packs
- Petroleum jelly
- Moisturizing creams
- Bleach baths
- Wet wrap therapy
- Avoiding triggers
Older treatment options also include broad-spectrum anti-inflammatories including:
- Topical corticosteroid creams
- Light therapy (phototherapy)
- Oral steroids such as cyclosporine
Until relatively recently, your atopic dermatitis treatment options were limited to these. They also weren’t specific in targeting the underlying causes of your skin flares as needed to allow long-term healing. For too many people with more moderate-to-severe atopic dermatitis, it wasn’t enough. While oral steroids can improve the skin symptoms, atopic dermatitis often flares when treatment is stopped. Systemic steroids also come with many side effects when taken long-term.
The goal of treating your atopic dermatitis is to ease your dry skin, reduce skin inflammation, and stop future flares. Today, you’ll have more cutting-edge and targeted options you can use topically or take systemically to address and reduce the underlying inflammatory responses and help you find relief.
What Are the Latest Treatments for Atopic Dermatitis?
A growing number of more targeted treatment options are now approved for treating atopic dermatitis in adults. Some of them also are approved for young children or teens. Targeted treatment options include pills, topical creams, and injected or infused biologics. You’ll likely use them in combination with moisturizing creams and other basic measures to protect and care for your skin.
Your newer treatment options include different drug classes that work in different ways to affect your immune system in various ways:
Interleukin (IL) inhibitors (biologics)
Janus kinase (JAK) inhibitors
PDE inhibitors
AhR agonists
Calcineurin inhibitors
All of these medicines are “targeted.” That means that they work by blocking a particular substance or molecule with the goal to tamp down your immune system and ease your atopic dermatitis. You’ll likely use them together with other strategies to avoid triggers and protect your skin.
To make informed treatment decisions together with your doctor, it will help you to understand how each of these medicines and drug classes works.
What Are IL Inhibitors?
IL is short for interleukin. Interleukins are a type of cytokine or chemical signal your cells make. They are important for communication to cells in your immune system. They may signal immune cells to turn on or become more active. They also may cause immune cells to multiply, mature, move from one place to another, or stick to certain spots. Interleukin proteins also drive inflammation and immune responses.
Atopic dermatitis is an immune condition in your skin. It’s driven mainly by interleukin cytokines. Two that are especially important in atopic dermatitis are IL-4 and IL-13. As a result, doctors consider IL-4 and IL-13 good targets for treating atopic dermatitis. IL inhibitors are medicines that work by blocking interleukins.
You’ll have multiple IL inhibitors to choose from. They are a type of medicine known as a biologic or monoclonal antibody. Biologics are medicines made from living cells. They are most often antibodies and proteins that block specific substances. Some IL inhibitors block only one interleukin while others block two. Dupilumab was the first IL inhibitor approved in 2017 for atopic dermatitis that didn’t respond to older, standard therapies. It works by blocking IL-4 and IL-13 to improve the skin barrier and reduce inflammation. Studies have shown it also improves:
- Itching
- Sleep quality
- Quality of life
Today you’ll have additional IL inhibitors, or biologic, medicines to choose from. While they all target interleukins, they have differences, too. For example, nemulizumab blocks a different interleukin, called IL-31, which plays an important role in symptoms of atopic dermatitis including itch, inflammation, and rash. It’s approved for use in treating moderate-to-severe atopic dermatitis in combination with topical treatments for people 12 and up.
You’ll take IL inhibitors or biologics either through your skin as an injection or in an infusion. Ask your doctor about your options for IL inhibitors, their benefits and risks, and what you can expect if you're taking one of them to treat your atopic dermatitis.
Learn more about IL inhibitors for atopic dermatitis.
What Are Janus Kinase (JAK) Inhibitors?
JAK inhibitors work in a different way to limit inflammation in atopic dermatitis. Instead of targeting interleukins, they target proteins known as Janus kinases (JAKs). JAKs receive signals from many different interleukins to drive inflammation. The JAK pathway is known to play a role in many immune-driven inflammatory conditions, including atopic dermatitis.
Some JAK inhibitors are taken by mouth as a pill. But the JAK inhibitor ruxolitinib is a topical treatment that works in the same targeted way for treating mild to moderate atopic dermatitis in people 12 and up. You may want to consider a JAK inhibitor when other treatments haven’t worked or if you’d rather take a pill or topical medicine over a medicine that has to be injected or infused.
Learn more about JAK inhibitors for atopic dermatitis.
What Are PDE Inhibitors?
PDE inhibitors are another topical option for atopic dermatitis, especially when it’s more moderate or mild. They’re called PDE inhibitors because they block an enzyme called phosphodiesterase 4 (PDE4). The PDE4 enzyme is involved in inflammation responses in your skin. When you have atopic dermatitis, this enzyme may be present at higher than normal levels or working too hard. By blocking its activity, it can help to reduce inflammation and eczema flares.
The PDE inhibitor crisaborole (Eucrisa) is approved for adults and kids. Roflumilast (Zoryve) is a cream that works in the same way. You’ll use PDE inhibitor creams once or twice daily. It’s approved for adults and kids aged 6 and up based on evidence it’s effective for many people with mild or moderate atopic dermatitis. So PDE inhibitors may be less likely to work if your atopic dermatitis is more severe.
What Are AhR Agonists?
AhR stands for aryl hydrocarbon receptor. It’s a topical treatment for atopic dermatitis that works by activating this receptor. When this receptor is activated, it helps to reduce inflammation. It also increases the activity of proteins that are important for your skin barrier to work well.
So far, tapinarof (Vtama) is the only medicine in this class. It was first approved to treat people with plaque psoriasis. Its approval was extended to atopic dermatitis based on evidence it could treat people with moderate-to-severe AD, including people of all skin types and ages.
What Are Topical Calcineurin Inhibitors (TCIs)?
Calcinuerin inhibitors are an older type of topical treatment for atopic dermatitis. You’ll have two calcineurin inhibitors to choose from: pimecrolimus cream or tacrolimus ointment. TCIs work by blocking a protein called calcineurin that’s involved in inflammation. Your doctor may suggest trying this first if you haven’t already if topical corticosteroids don’t work or stop working before moving on to other options.
Things to Consider When Choosing a Treatment
There are lots to think about when choosing a treatment for your atopic dermatitis. See a dermatologist with experience treating moderate-to-severe atopic dermatitis for advice if you haven’t already. Treatment approaches for this skin condition will depend on how severe your atopic dermatitis is. Your doctor can help you come up with a treatment plan that suits you best. It may include steps to avoid things that trigger your flares. Some common triggers may include allergens, food allergies, skin irritants, sweat, and stress. Over-the counter medicines, creams, and ointments may help, too. Especially when atopic dermatitis is moderate to severe, you shouldn’t stop there.
Your doctor can help you understand the severity based on how much of your body is affected, how intense the redness and swelling is, how itchy it is, and how much it’s affecting your ability to sleep and mental health. Talk to your doctor about your treatment options to get your atopic dermatitis under good control and help to prevent future flare-ups. Many prescription treatment options work by blocking the immune responses that drive atopic dermatitis flares in different ways. Some of them are more specific than others and side effects also will vary.
Some key factors to consider and talk with your doctor about include:
- How much of your body is affected
- How intense the inflamed patches are on your skin
- How bothersome the itchiness or other symptoms are
- Your treatment preferences, for instance whether you’d prefer a topical, oral medicine, or biologic
- How well other treatments, such as topical corticosteroids, are working
- Your health insurance coverage
- Treatment side effects and risks for complications
Before adjusting your current treatment plan, your doctor may:
- Make sure you have the right diagnosis
- Consider any other health conditions you have
- Make sure you are well informed about atopic dermatitis and basic skin care
- Address ways to avoid any known triggers
- Make sure you’ve been following your current treatment plan
- Encourage you to use moisturizer at least once every day
Moisturizers and topical steroids are still considered mainstays of treatment for atopic dermatitis. Your doctor will likely advise you to keep using them even if you try other medicines. You’re most likely to move on to systemic treatments, including IL inhibitors or JAK inhibitors, when other topical therapies aren’t working.
Here Are Five Key Things to Consider
Atopic dermatitis severity
Some treatments are approved to treat mild to moderate atopic dermatitis, while others may be better choices when your eczema is moderate to more severe. Ask your doctor about the severity of your atopic dermatitis and which treatment options are most likely to give you the most benefit without taking unnecessary risks.
How you’d like to deliver the medicine
Treatment options include pills or topical medicines you would take or apply daily. Others will involve injections or infusions you'd need less often. The best treatment options when moderate or severe atopic dermatitis doesn’t respond to other approaches will depend on your lifestyle and personal preferences.
Treatment monitoring and adherence
Your treatment may affect how often you’ll need to see your doctor for blood tests and other monitoring. One of the reasons treatments for atopic dermatitis don’t always work is that people find it hard to stick with their treatment plan.
Factors that can affect your ability to stick with treatment include:
- Frustration
- Inconvenience
- Fear of side effects
- Forgetfulness
- Financial concerns
- Distrust
- Lack of understanding
Be sure to talk to your doctor about any concerns you have and ask questions to find a treatment plan that’s more likely to be effective for you.
Side effects or safety concerns
Some treatment options for atopic dermatitis have a longer track record for safety. The expected side effects or complications risks also will vary. For example, JAK inhibitors come with a black box warning for adverse events including:
- Major cardiovascular events
- Blood clots
- Cancer
- Serious infection
- Death
It’s important to talk to your doctor about any potential side effects and risks and consider any other health conditions or concerns you may have.
Your health insurance plan
You’ll want to make sure your health insurance plan covers your care team, tests, and treatments you’ll need. Consider the treatment you're using now and how much you’ll pay out-of-pocket. Talk to your doctor about other options you may wish to consider if current treatments don’t work well enough or stop working. Make sure to factor in any tests or other procedures your treatment plan may require.