ABSTRACT
This chapter deals with topical therapy. It aims to provide treatment recommendations supported by rigorous studies conforming to principles of evidence-based medicine. Topical corticosteroids have been the uncontested gold standard of therapy for atopic dermatitis (AP). Corticosteroid preparations remain the topical option most likely to succeed in the acute management of severe AP. Doxepin 5% cream is indicated in the USA for the short-term treatment of moderate pruritus associated with AP in adults, but carries the risk of sensitization and somnolence. Tacrolimus ointment may be used alone or in combination to treat all severities of APs, whereas pimecrolimus cream is indicated only for milder disease, mostly as a steroid-sparing agent. The US Food and Drug Administration approved several products as medical devices for treating signs and symptoms of AP. A significant paradigm shift occurred in the treatment of atopic eczema with the introduction of topical calcineurin inhibitors.
