In addition to emollients, NICE recommends mild potency topical corticosteroids for mild AD, and to step up steroid strength if AD severity increases. Bandages with emollient may also help moderate or severe AD, but occlusive medicated dressings or dry bandages should not be used.18

Topical calcineurin inhibitors (TCIs - tacrolimus or pimecrolimus) can be introduced for moderate or severe AD for patients unresponsive to, or unable to tolerate conventional therapy. NICE says the drugs should not be used to treat mild AD, nor be used as first line treatments. Usage should be monitored and not prolonged without treatment breaks.19

In severe AD, PUVA phototherapy (psoralens with UVA) or systemic therapy (eg a retinoid or ciclosporin) are also options under specialist supervision.18

Before prescribing any antibiotics, infected eczematous skin should be tested to determine the microorganism. Antiseptics such as triclosan or chlorhexidine may help. If infected skin does not respond to antibacterial treatment, herpes simplex could be present.18

NICE warns against, but does not preclude, using oral antihistamines routinely in AD. If itching is severe, consider a non-sedating antihistamine for a month trial. If successful, and other symptoms persist, the antihistamine can continue, but review usage every three months. Age-appropriate sedating antihistamines may help children in flare ups if sleep is disturbed, but this should be on a 1-2 week trial basis.18