Summarizing Topical Options: Treating Atopic Dermatitis (AD) Across Every Age

Summarizing Topical Options: Treating Atopic Dermatitis (AD) Across Every Age

First-Line Therapies

Emollients and Moisturizers

• Foundation of all AD management regardless of age
• Apply 2-3 times daily, especially after bathing
• Ceramide-containing formulations may provide superior barrier repair
• Ointments preferred for severe dryness; creams and lotions for better cosmetic acceptability

Topical Corticosteroids (TCS)

• Potency selection based on age, location, and severity
• Infants: Low potency only (hydrocortisone 1-2.5%)
• Children: Low to mid-potency for body; low potency for face/intertriginous areas
• Adolescents/Adults: Full potency range appropriate with location-based selection
• Apply once or twice daily during flares
• Proactive twice-weekly application reduces relapse rates

Second-Line Therapies

Topical Calcineurin Inhibitors (TCIs)

• Tacrolimus 0.03% (ages ≥2) and 0.1% (ages ≥16)
• Pimecrolimus 1% (ages ≥2)
• Preferred for face, neck, and intertriginous areas across all age groups
• No risk of skin atrophy; suitable for long-term maintenance
• Initial application burning more pronounced in younger patients

Phosphodiesterase-4 (PDE4) Inhibitors

• Crisaborole 2% ointment approved for ages ≥3 months
• Apply twice daily to affected areas
• Well-tolerated in pediatric populations
• Useful for steroid-sensitive locations
• Consider for maintenance therapy after flare control with TCS

Emerging Options

Topical JAK Inhibitors

• Ruxolitinib 1.5% cream approved for ages ≥12 years
• Not approved for immunocompromised patients
• Rapid itch relief (within 8-12 hours)
• Limited to ≤20% BSA application
• Not recommended for children <12 years pending additional safety data

Antimicrobial Approaches

• Reserved for clinically infected lesions
• Bleach baths (0.005-0.0125%) twice weekly beneficial across all ages
• Antiseptic washes may help manage bacterial colonization
• Antibiotic-containing combination products only for short-term use

Age-Specific Considerations

Infants (0-2 years)

• Emphasize non-pharmacologic approaches
• Limited use of TCS (low potency only)
• Careful attention to application amounts
• Wet wrap therapy effective for severe flares
• Avoid TCIs under age 2 (off-label if used)

Children (2-12 years)

• Education on self-care increasingly important
• Monitor for growth effects with potent TCS
• TCIs and PDE4 inhibitors particularly valuable
• School considerations (treatment timing, stigma)
• Simplified regimens to improve adherence

Adolescents (12-18 years)

• Vehicle selection critical for adherence
• Cosmetically acceptable options for visible areas
• Transition to self-management with supervision
• Consider impact on social development
• Attention to treatment burden during school/activities

Adults (>18 years)

• Occupational considerations for hand dermatitis
• Treatment of specific distribution patterns (head/neck, hand/foot)
• Pregnancy considerations for reproductive-age women
• Focus on long-term maintenance strategies
• Cosmetic aspects may drive vehicle preferences

Practical Treatment Strategies

• "Weekend therapy" maintenance regimen for all ages
• Step-up/step-down approaches based on disease activity
• Rotation between different agent classes for recalcitrant areas
• Written action plans for flare management
• Regular reassessment of treatment effectiveness and side effects