Drugs & Therapy Perspectives

, Volume 35, Issue 2, pp 58–63 | Cite as

When managing atopic dermatitis-related itch, use a step-wise approach, address barrier repair and educate patients

  • Adis Medical WritersEmail author
Disease Management


Itch (pruritus) is a key clinical feature of atopic dermatitis, has a complex pathogenesis and markedly affects health-related quality of life. Treatment differs according to itch severity, but should always include the use of barrier creams and moisturizers/emollients, as well as patient education and lifestyle advice to manage sleep and reduce stress. Depending on itch severity, treatment with topical corticosteroids, systemic immunosuppressants and other pharmacological and nonpharmacological options may be added using a stepwise treatment approach.


Compliance with ethical standards

Conflict of interest

The article was adapted from the American Journal of Clinical Dermatology 2018;19(3):319–32 [1] by employees of Adis/Springer, who are responsible for the article content and declare no conflicts of interest.


The preparation of this review was not supported by any external funding.


  1. 1.
    Pavlis J, Yosipovitch G. Management of itch in atopic dermatitis. Am J Clin Dermatol. 2018;19(3):319–32.CrossRefGoogle Scholar
  2. 2.
    Dawn A, Papoiu AD, Chan YH, et al. Itch characteristics in atopic dermatitis: results of a web-based questionnaire. Br J Dermatol. 2009;160(3):642–4.CrossRefGoogle Scholar
  3. 3.
    van Zuuren EJ, Fedorowicz Z, Arents BWM. Emollients and moisturisers for eczema: abridged Cochrane systematic review including GRADE assessments. Br J Dermatol. 2017;177(5):1256–71.CrossRefGoogle Scholar
  4. 4.
    Szczepanowska J, Reich A, Szepietowski JC. Emollients improve treatment results with topical corticosteroids in childhood atopic dermatitis: a randomized comparative study. Pediatr Allergy Immunol. 2008;19(7):614–8.CrossRefGoogle Scholar
  5. 5.
    Lee HG, Grossman SK, Valdes-Rodriguez R, et al. Topical ketamine-amitriptyline-lidocaine for chronic pruritus: a retrospective study assessing efficacy and tolerability. J Am Acad Dermatol. 2017;76(4):760–1.CrossRefGoogle Scholar
  6. 6.
    Kaufmann R, Bieber T, Helgesen AL, et al. Onset of pruritus relief with pimecrolimus cream 1% in adult patients with atopic dermatitis: a randomized trial. Allergy. 2006;61(3):375–81.CrossRefGoogle Scholar
  7. 7.
    Langley RG, Eichenfield LF, Lucky AW, et al. Sustained efficacy and safety of pimecrolimus cream 1% when used long-term (up to 26 weeks) to treat children with atopic dermatitis. Pediatr Dermatol. 2008;25(3):301–7.CrossRefGoogle Scholar
  8. 8.
    Lynde CW, Andriessen A. A cohort study on a ceramide-containing cleanser and moisturizer used for atopic dermatitis. Cutis. 2014;93(4):207–13.Google Scholar
  9. 9.
    Lisante TA, Nunez C, Zhang P, et al. A 1% colloidal oatmeal cream alone is effective in reducing symptoms of mild to moderate atopic dermatitis: results from two clinical studies. J Drugs Dermatol. 2017;16(7):671–6.Google Scholar
  10. 10.
    Draelos ZD, Stein Gold LF, Murrell DF, et al. Post hoc analyses of the effect of crisaborole topical ointment, 2% on atopic dermatitis: associated pruritus from phase 1 and 2 clinical studies. J Drugs Dermatol. 2016;15(2):172–6.Google Scholar
  11. 11.
    Zane LT, Kircik L, Call R, et al. Crisaborole topical ointment, 2% in patients ages 2 to 17 years with atopic dermatitis: a phase 1b, open-label, maximal-use systemic exposure study. Pediatr Dermatol. 2016;33(4):380–7.CrossRefGoogle Scholar
  12. 12.
    Wong SM, Ng TG, Baba R. Efficacy and safety of sodium hypochlorite (bleach) baths in patients with moderate to severe atopic dermatitis in Malaysia. J Dermatol. 2013;40(11):874–80.CrossRefGoogle Scholar
  13. 13.
    Simpson EL, Bieber T, Guttman-Yassky E, et al. Two phase 3 trials of dupilumab versus placebo in atopic dermatitis. N Engl J Med. 2016;375(24):2335–48.CrossRefGoogle Scholar
  14. 14.
    Roekevisch E, Spuls PI, Kuester D, et al. Efficacy and safety of systemic treatments for moderate-to-severe atopic dermatitis: a systematic review. J Allergy Clin Immunol. 2014;133(2):429–38.CrossRefGoogle Scholar
  15. 15.
    Berth-Jones J, Takwale A, Tan E, et al. Azathioprine in severe adult atopic dermatitis: a double-blind, placebo-controlled, crossover trial. Br J Dermatol. 2002;147(2):324–30.CrossRefGoogle Scholar
  16. 16.
    Pacor ML, Di Lorenzo G, Martinelli N, et al. Comparing tacrolimus ointment and oral cyclosporine in adult patients affected by atopic dermatitis: a randomized study. Clin Exp Allergy. 2004;34(4):639–45.CrossRefGoogle Scholar
  17. 17.
    Harper JI, Ahmed I, Barclay G, et al. Cyclosporin for severe childhood atopic dermatitis: short course versus continuous therapy. Br J Dermatol. 2000;142(1):52–8.CrossRefGoogle Scholar
  18. 18.
    Dawn AG, Yosipovitch G. Butorphanol for treatment of intractable pruritus. J Am Acad Dermatol. 2006;54(3):527–31.CrossRefGoogle Scholar
  19. 19.
    LeBovidge J, Borok J, Udkoff J, et al. Atopic dermatitis: therapeutic care delivery: therapeutic education, shared decision-making, and access to care. Semin Cutan Med Surg. 2017;36(3):131–6.CrossRefGoogle Scholar
  20. 20.
    Staab D, Diepgen TL, Fartasch M, et al. Age related, structured educational programmes for the management of atopic dermatitis in children and adolescents: multicentre, randomised controlled trial. BMJ. 2006;332(7547):933–8.CrossRefGoogle Scholar
  21. 21.
    Reynolds NJ, Franklin V, Gray JC, et al. Narrow-band ultraviolet B and broad-band ultraviolet a phototherapy in adult atopic eczema: a randomised controlled trial. Lancet. 2001;357(9273):2012–6.CrossRefGoogle Scholar
  22. 22.
    Wallengren J, Sundler F. Phototherapy reduces the number of epidermal and CGRP-positive dermal nerve fibres. Acta Derm Venereol. 2004;84(2):111–5.CrossRefGoogle Scholar
  23. 23.
    Belgrade MJ, Solomon LM, Lichter EA. Effect of acupuncture on experimentally induced itch. Acta Derm Venereol. 1984;64(2):129–33.Google Scholar
  24. 24.
    Pfab F, Hammes M, Backer M, et al. Preventive effect of acupuncture on histamine-induced itch: a blinded, randomized, placebo-controlled, crossover trial. J Allergy Clin Immunol. 2005;116(6):1386–8.CrossRefGoogle Scholar
  25. 25.
    Pfab F, Huss-Marp J, Gatti A, et al. Influence of acupuncture on type I hypersensitivity itch and the wheal and flare response in adults with atopic eczema: a blinded, randomized, placebo-controlled, crossover trial. Allergy. 2010;65(7):903–10.CrossRefGoogle Scholar

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© Springer Nature Switzerland AG 2018

Authors and Affiliations

  1. 1.SpringerAucklandNew Zealand

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