Atopic Dermatitis Treatment

Regular use of fragrance-free, hypoallergenic moisturizers helps to restore the skin’s barrier and retain moisture. Dr. Monjazeb emphasizes that lotions have a higher percentage of alcohol which can sting on contact in patients with a compromised skin barrier. Thick ointments and creams are generally more effective than lotions and more tolerable. Patients with atopic dermatitis have skin that are lacking ceramides. Moisturizes like CeraVe and Cetaphil are formulated with ceramides to help restore your ceramide deficiency and is often what Dr. Monjazeb recommends.

• Corticosteroids: Reduce inflammation and itching during flare-ups. Patients will often bring up the concern of steroid withdrawal during examinations. Dr. Seena Monjazeb explains that when used appropriately and for short periods of time the risk of steroid withdrawal is low. If longer term use ends up being needed, steroid sparing agents are preferred. Instructions will be provided during your visit about proper use of all medications.
• Calcineurin Inhibitors: Such as tacrolimus and pimecrolimus are non-steroidal creams that are effective for sensitive areas like the face.
• Phosphodiesterase-4 Inhibitors: Crisaborole can reduce inflammation and itching.

• Antihistamines: As the itch in atopic dermatitis is not related to histamine, antihistamines have a limited role in the treatment regimen, however they may be used to improve sleep
• Immunosuppressants: For severe cases, drugs like prednisone, cyclosporine or methotrexate may be prescribed to control immune responses.

Newer treatments like dupilumab, branded as Dupixent, target specific pathways in the immune system and are highly effective for moderate to severe atopic dermatitis. Approved by the FDA, dupilumab is the first targeted therapy specifically designed to address the underlying immune dysfunction that drives atopic dermatitis, rather than merely alleviating symptoms. This helps provide long lasting relief without the use of chronic steroids. Dupilumab has revolutionized atopic dermatitis treatment allowing many patients to not have to use any topical prescription medications.

Dupilumab works by inhibiting the activity of interleukin-4 (IL-4) and interleukin-13 (IL-13), two key proteins involved in the overactive immune response associated with the condition. By targeting this pathway, dupilumab reduces inflammation, alleviates itching, and helps restore the  natural barrier of the skin.

Administered via subcutaneous injection every two to four weeks, dupilumab is used for patients whose symptoms cannot be adequately controlled with topical treatments or who require systemic therapy. Clinical trials have demonstrated significant improvements in skin clearance, itch reduction, and overall quality of life in patients treated with dupilumab. The FDA has approved this medication from 6 months of age and up. Dr. Monjazeb specializes in clearing the most severe cases using medications such as dupliumab.

Avoiding known triggers, wearing breathable fabrics, and maintaining a consistent skincare routine can significantly reduce flare-ups. A personalized routine will be created for you during your visit to help optimize your skincare regimen. It is not standard to avoid certain foods as studies have not consistently shown a link between specific foods and atopic dermatitis flare ups. However, certain patients may see a rash develop after certain foods.