Editing Dermatitis (section)

===Medications===

====Corticosteroids====
If symptoms are well controlled with moisturizers, steroids may only be required when flares occur.<ref name=Mc2012/> [[Corticosteroids]] are effective in controlling and suppressing symptoms in most cases.<ref name="pmid11134919">{{cite journal|vauthors=Hoare C, Li Wan Po A, Williams H|year=2000|title=Systematic review of treatments for atopic eczema|url=https://doi.org/10.3310%2Fhta4370|url-status=|journal=[[Health Technology Assessment (journal)|Health Technology Assessment]]|volume=4|issue=37|pages=1–191|doi=10.3310/hta4370|pmc=4782813|pmid=11134919|access-date=18 November 2009}}{{deadlink|date=September 2023}}</ref> Once daily use is generally enough.<ref name=Mc2012/> For mild-moderate eczema a weak steroid may be used (e.g., [[hydrocortisone]]), while in more severe cases a higher-potency steroid (e.g., [[clobetasol propionate]]) may be used. In severe cases, oral or injectable corticosteroids may be used. While these usually bring about rapid improvements, they have greater side effects.

<!-- Adverse effects including topical steroid addiction/withdrawal-->
Long term use of topical steroids may result in [[skin atrophy]], [[stria]], and [[telangiectasia]].<ref name=Mc2012/> Their use on delicate skin (face or groin) is therefore typically with caution.<ref name=Mc2012/> They are, however, generally well tolerated.<ref>{{cite journal | vauthors = Bewley A | title = Expert consensus: time for a change in the way we advise our patients to use topical corticosteroids | journal = The British Journal of Dermatology | volume = 158 | issue = 5 | pages = 917–920 | date = May 2008 | pmid = 18294314 | doi = 10.1111/j.1365-2133.2008.08479.x | s2cid = 46445371 | doi-access = free }}</ref> [[Red burning skin]], where the skin turns red upon stopping steroid use, has been reported among adults who use topical steroids at least daily for more than a year.<ref name=Oak2016>{{cite web| vauthors = Oakley A |title=Topical corticosteroid withdrawal|url=http://www.dermnetnz.org/reactions/topical-steroid-withdrawal.html|website=DermNet NZ|publisher=DermNet New Zealand Trust|url-status=live|archive-url=https://web.archive.org/web/20160316135658/http://www.dermnetnz.org/reactions/topical-steroid-withdrawal.html|archive-date=16 March 2016}}</ref>

==== Antihistamines ====
There is little evidence supporting the use of [[antihistamine]] medications for the relief of dermatitis.<ref name="Mc2012" /><ref>{{cite journal | vauthors = Apfelbacher CJ, van Zuuren EJ, Fedorowicz Z, Jupiter A, Matterne U, Weisshaar E | title = Oral H1 antihistamines as monotherapy for eczema | journal = The Cochrane Database of Systematic Reviews | issue = 2 | pages = CD007770 | date = February 2013 | volume = 2013 | pmid = 23450580 | pmc = 6823266 | doi = 10.1002/14651858.CD007770.pub2 | url = http://www.cochrane.org/CD007770/SKIN_effects-antihistamines-eczema }}</ref> Sedative antihistamines, such as [[diphenhydramine]], may be useful in those who are unable to sleep due to eczema.<ref name="Mc2012" /> Second generation antihistamines have minimal evidence of benefit.<ref name="Matt2019" /> Of the second generation antihistamines studied, [[fexofenadine]] is the only one to show evidence of improvement in itching with minimal side effects.<ref name="Matt2019">{{cite journal | vauthors = Matterne U, Böhmer MM, Weisshaar E, Jupiter A, Carter B, Apfelbacher CJ | title = Oral H1 antihistamines as 'add-on' therapy to topical treatment for eczema | journal = The Cochrane Database of Systematic Reviews | volume = 1 | pages = CD012167 | date = January 2019 | issue = 1 | pmid = 30666626 | pmc = 6360926 | doi = 10.1002/14651858.CD012167.pub2 }}</ref>

====Immunosuppressants====
[[File:Protopic.JPG|thumb|Tacrolimus 0.1%]]
Topical [[immunosuppressant]]s like [[pimecrolimus]] and [[tacrolimus]] may be better in the short term and appear equal to steroids after a year of use.<ref>{{cite journal | vauthors = Shams K, Grindlay DJ, Williams HC | title = What's new in atopic eczema? An analysis of systematic reviews published in 2009-2010 | journal = Clinical and Experimental Dermatology | volume = 36 | issue = 6 | pages = 573–577; quiz 577–578 | date = August 2011 | pmid = 21718344 | doi = 10.1111/j.1365-2230.2011.04078.x | s2cid = 42321918 | doi-access = free }}</ref> Their use is reasonable in those who do not respond to or are not tolerant of steroids.<ref name="Carr2013">{{cite journal | vauthors = Carr WW | title = Topical calcineurin inhibitors for atopic dermatitis: review and treatment recommendations | journal = Paediatric Drugs | volume = 15 | issue = 4 | pages = 303–310 | date = August 2013 | pmid = 23549982 | pmc = 3715696 | doi = 10.1007/s40272-013-0013-9 }}</ref><ref>{{cite web|url=http://www.nhs.uk/Conditions/Eczema-(atopic)/Pages/Treatment.aspx|title=Atopic eczema - Treatment|publisher=NHS Choices, London, UK|date=12 February 2016|access-date=27 January 2017|url-status=live|archive-url=https://web.archive.org/web/20170116200857/http://www.nhs.uk/Conditions/Eczema-(atopic)/Pages/treatment.aspx|archive-date=16 January 2017}}</ref> Treatments are typically recommended for short or fixed periods of time rather than indefinitely.<ref name=Mc2012/><ref name="fda14">{{cite web|url=https://www.fda.gov/downloads/drugs/drugsafety/ucm088587.pdf|title=Medication Guide. Elidel® (pimecrolimus) Cream, 1%|publisher=US Food and Drug Administration|date=March 2014|access-date=27 January 2017|url-status=live|archive-url=https://web.archive.org/web/20170211080101/https://www.fda.gov/downloads/Drugs/DrugSafety/UCM088587.pdf|archive-date=11 February 2017}}</ref> Tacrolimus 0.1% has generally proved more effective than pimecrolimus, and equal in effect to mid-potency topical steroids.<ref name=Tor2013>{{cite journal | vauthors = Torley D, Futamura M, Williams HC, Thomas KS | title = What's new in atopic eczema? An analysis of systematic reviews published in 2010–11 | journal = Clinical and Experimental Dermatology | volume = 38 | issue = 5 | pages = 449–456 | date = July 2013 | pmid = 23750610 | doi = 10.1111/ced.12143 | s2cid = 24638685 }}</ref> There is no association to increased risk of cancer from topical use of pimecrolimus nor tacrolimus.<ref name=fda14/><ref>{{Cite journal |last1=Devasenapathy |first1=Niveditha |last2=Chu |first2=Alexandro |last3=Wong |first3=Melanie |last4=Srivastava |first4=Archita |last5=Ceccacci |first5=Renata |last6=Lin |first6=Clement |last7=MacDonald |first7=Margaret |last8=Wen |first8=Aaron |last9=Steen |first9=Jeremy |last10=Levine |first10=Mitchell |last11=Pyne |first11=Lonnie |last12=Schneider |first12=Lynda |last13=Chu |first13=Derek K. |last14=Asiniwasis |first14=Rachel Netahe |last15=Boguniewicz |first15=Mark|date=1 January 2023 |title=Cancer risk with topical calcineurin inhibitors, pimecrolimus and tacrolimus, for atopic dermatitis: a systematic review and meta-analysis |url=https://www.thelancet.com/journals/lanchi/article/PIIS2352-4642(22)00283-8/abstract |journal=The Lancet Child & Adolescent Health |language=English |volume=7 |issue=1 |pages=13–25 |doi=10.1016/S2352-4642(22)00283-8 |issn=2352-4642 |pmid=36370744|s2cid=253470127 }}</ref>

When eczema is severe and does not respond to other forms of treatment, systemic [[immunosuppressant]]s are sometimes used. Immunosuppressants can cause significant side effects and some require regular blood tests. The most commonly used are [[cyclosporin]], [[azathioprine]], and [[methotrexate]].

[[Dupilumab]] is a new{{notetag|[[Dupilumab]] received approval from the US [[Food and Drug Administration]] for moderate-to-severe atopic dermatitis in 2017<ref>{{cite web |url=https://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm549078.htm |title=FDA approves new eczema drug Dupixent |publisher=U.S. [[Food and Drug Administration]] (FDA) |date=10 September 2019 |access-date=29 March 2017 |archive-date=28 March 2017 |archive-url=https://web.archive.org/web/20170328204026/https://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm549078.htm |url-status=live }}</ref> and for asthma in 2018.<ref>{{cite web | title=Dupixent- dupilumab injection, solution | publisher=[[DailyMed]] | date=25 June 2020 | url=https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=595f437d-2729-40bb-9c62-c8ece1f82780 | access-date=17 September 2020 | archive-date=24 March 2021 | archive-url=https://web.archive.org/web/20210324191531/https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=595f437d-2729-40bb-9c62-c8ece1f82780 | url-status=live }}</ref>}} medication that improves eczema lesions, especially moderate to severe eczema.<ref>{{cite journal | vauthors = Sawangjit R, Dilokthornsakul P, Lloyd-Lavery A, Lai NM, Dellavalle R, Chaiyakunapruk N | title = Systemic treatments for eczema: a network meta-analysis | journal = The Cochrane Database of Systematic Reviews | volume = 2020 | pages = CD013206 | date = September 2020 | issue = 9 | pmid = 32927498 | pmc = 8128359 | doi = 10.1002/14651858.cd013206.pub2 }}</ref> Dupilumab, a monoclonal antibody, suppresses inflammation by targeting the [[interleukin-4 receptor]].

====Antifungals====
[[Antifungal]]s are used in the treatment of [[seborrheic dermatitis]].<ref name=Bor2019/>

==== Others ====
In September 2021, [[ruxolitinib|ruxolitinib cream]] (Opzelura) was approved by the U.S. [[Food and Drug Administration]] (FDA) for the topical treatment of mild to moderate atopic dermatitis.<ref name="Incyte PR 20210921">{{cite web | title=Incyte Announces U.S. FDA Approval of Opzelura (ruxolitinib) Cream, a Topical JAK Inhibitor, for the Treatment of Atopic Dermatitis (AD) | publisher=Incyte | via=Business Wire | date=21 September 2021 | url=https://www.businesswire.com/news/home/20210921006072/en/ | access-date=21 September 2021}}</ref> It is a topical [[Janus kinase inhibitor]].<ref name="Incyte PR 20210921" />