Last updated January 12, 2023

Management of Atopic Dermatitis in Adults with Topical Therapies

Non-prescription therapies

For adults with AD, we recommend the use of moisturizers. (S, M)
Remark: The use of a particular moisturizer or active ingredient in an emollient cannot be recommended based on the limited available evidence.
620

For adults with AD, we conditionally recommend bathing for treatment and maintenance. (C, L)
Remark: A standard for the frequency or duration of bathing appropriate for those with AD cannot be suggested based on the limited available evidence.
620

For adults with moderate-to-severe AD experiencing a flare, we conditionally recommend the use of wet dressings. (C, L)
620

Topical calcineurin inhibitors

For adults with AD, we recommend the use of tacrolimus 0.03% or 0.1%. (S, H)
620

For adults with mild-to-moderate AD, we recommend the use of pimecrolimus 1% cream. (S, H)
620

Topical corticosteroids

For adults with AD, we recommend topical corticosteroids. (S, H)
620

For adults with AD, we recommend intermittent use of medium potency topical corticosteroids as maintenance therapy (2 times/week) to reduce disease flares and relapse. (S, H)
620

Topical antimicrobials/antiseptics and antihistamines

We conditionally recommend against the use of topical antimicrobials for AD in adults. (C, L)
620

We conditionally recommend against the use of topical antihistamines for AD in adults. (C, L)
620

We conditionally recommend against the use of topical antiseptics for AD in adults. (C, VL)
Remark: For patients with moderate-to-severe AD and clinical signs of secondary bacterial infection, bleach baths or the use of topical sodium hypochlorite may be suggested to reduce disease severity.
620

Topical PDE-4 inhibitors

For adults with mild-to-moderate AD, we recommend the use of crisaborole. (S, H)
620

Topical JAK inhibitors

For adults with mild-to-moderate AD, we recommend the use of ruxolitinib cream. (S, M)
620

Tables

Relative Potencies of topical Corticosteroids

Drug Dosage form(s) Strength (%)
I. Very High Potency
Augmented betamethasone dipropionate Ointment 0.05
Clobetasol propionate Cream, foam, ointment 0.05
Diflorasone diacetate Ointment 0.05
Halobetasol propionate Cream, ointment 0.05
II. High Potency
Amcinonide Cream, lotion, ointment 0.1
Augmented betamethasone dipropionate Cream 0.05
Betamethasone dipropionate Cream, foam, ointment, solution 0.05
Desoximetasone Cream, ointment 0.25
Desoximetasone Gel 0.05
Diflorasone diacetate Cream 0.05
Fluocinonide Cream, gel, ointment, solution 0.05
Halcinonide Cream ointment 0.1
Mometasone furoate Ointment 0.1
Triamcinolone acetonide Cream, ointment 0.5
III-IV. Medium Potency
Betamethasone valerate Cream, foam, lotion, ointment 0.1
Clocortolone pivalate Cream 0.1
Desoximetasone Cream 0.05
Fluocinolone acetonide Cream, ointment 0.025
Flurandrenolide Cream, ointment 0.05
Fluticasone propionate Cream 0.05
Fluticasone propionate Ointment 0.005
Mometasone furoate Cream 0.1
Triamicnolone acetonide Cream, ointment 0.1
V. Lower-Medium Potency
Hydrocortisone butyrate Cream, ointment, solution 0.1
Hydrocortisone probutate Cream 0.1
Hydrocortisone valerate Cream, ointment 0.2
Prednicarbate Cream 0.1
VI. Low Potency
Alclometasone dipropionate Cream, ointment 0.05
Desonide Cream, gel, foam, ointment 0.05
Fluocinolone acetonide Cream, solution 0.01
VII. Lowest Potency
Dexamethasone Cream 0.1
Hydrocortisone Cream, lotion, ointment, solution 0.25, 0.5, 1
Hydrocortisone acetate Cream, ointment 0.5-1

Recommendation Grading

Overview

Title

Management of Atopic Dermatitis in Adults with Topical Therapies

Authoring Organization

Publication Month/Year

January 11, 2023

Document Type

Guideline

Country of Publication

US

Document Objectives

To provide evidence-based recommendations related to management of AD in adults 96 using topical treatments

Target Patient Population

Adults 18 years of age and older with a clinical diagnosis of atopic dermatitis

Target Provider Population

Dermatologists, allergists and immunologists, family physicians and other providers treating adults with atopic dermatitis

Inclusion Criteria

Male, Female, Adult, Older adult

Health Care Settings

Ambulatory

Intended Users

Nurse, nurse practitioner, physician, physician assistant

Scope

Treatment, Management

Diseases/Conditions (MeSH)

D003876 - Dermatitis, Atopic

Keywords

dermatitis, eczema, atopic dermatitis, AD, topicals, atopic eczema

Source Citation

Sidbury R, Alikhan A, Bercovitch L, Cohen DE, Darr JM, Drucker AM, Eichenfield LF, Frazer-Green L, Paller AS, Schwarzenberger K, Silverberg JI, Singh AM, Wu PA, Davis DMR, Guidelines of care for the management of atopic dermatitis in adults with topical therapies, Journal of the American Academy of Dermatology (2023), doi: https://doi.org/10.1016/j.jaad.2022.12.029.