Drug Comments Side effects
Topical
Corticosteroids The mainstay of therapy; for reactive and proactive use. Extensive experience with the Fingertip Unit method (see text). With prolonged use: skin atrophy, hypertrichosis, depigmentation, and telangiectasias. Systemic absorption, particularly in dysmature infants.
Calcineurin inhibitors Safe, also < 2 years of age (off-label). Initially stinging/burning on the application sites.
PDE4 inhibitors Not available in Europe. Temporary stinging/burning on the application sites.
Wet wraps Good alternative to systemic medication for crisis intervention or averting hospitalization. Folliculitis. Systemic absorption/Cushing in prolonged use. Not indicated during puberty because of side effects of the corticosteroids (striae).
Antiseptics Topical disinfectants (e.g. bleach) may be used but evidence is conflicting. Rarely allergic reactions.
Systemic
Phototherapy Not commonly used in early childhood (feasibility). If used, preference for narrowband ultraviolet B (311nm) or ultraviolet A1. Claustrophobia in small children, erythema/burns, premature ageing of the skin, photocarcinogenity.
Antibiotics Topical antibiotics are not advised; in case of superinfection systemic antibiotics are warranted. Gastrointestinal problems, allergies / drug reactions (rare).
Cyclosporine A Approved from the age of 16. Hypertension, nephrotoxicity, tremor, hyperlipidemia.
Methotrexate Safe in children but off-label and effect takes longer than cyclosporine A. Folic acid suppletion recommended. Hepatotoxicity, gastrointestinal discomfort.
Azathioprine Off label. Superinfection, nausea, hepatic function abnormality, malignancies.
Mycophenolate mofetil Off label. Superinfection, anemia, leukopenia, diarrhea.
Dupilumab Biologic (injection). Approved from the age of 12. Conjunctivitis, injection site reactions.