Atopic Dermatitis : Drug Summary

Antihistamines and Antiallergics (Oral)

Drug	Dosage		Remarks
Drug	Children	Adult	Remarks
First Generation
Azatadine	6-12 years old: 0.5-1 mg PO 12 hourly	1-2 mg PO 12 hourly	Adverse Reactions Most common: CNS effects (drowsiness, lassitude, dizziness, incoordination, paradoxical stimulation) Other common: CNS effects (headache, psychomotor impairment); Antimuscarinic effects (dry mouth, viscous secretions, urinary retention, blurred vision) Occasionally can cause GI effects (nausea and vomiting, diarrhea, epigastric pain, anorexia or increased appetite); CV effects (palpitations, arrhythmias, rarely hazardous ventricular arrhythmias); Hypersensitivity reactions (rashes, angioedema, anaphylaxis); Other effects (convulsion, sweating, myalgia, tremor, hypotension) Promethazine may sometimes cause photosensitivity or jaundice Special Instructions Avoid use in patients who need mental alertness (eg driving or using machines) and with alcohol intake Use with caution in patients with angle-closure glaucoma, urinary retention, prostatic hyperplasia, epilepsy, renal or hepatic impairment Reduction of dosage may be needed
Brompheniramine	2-6 years olf: 1 mg PO 4-6 hourly >6-12 years old: 2 mg PO 4-6 hourly 12 years old: 4 mg PO 4-6 hourly	4 mg PO 4-6 hourly
Buclizine	-	25-50 mg/day PO Max dose: 100 mg/day
Chlorpheniramine	Regular-release: 1-2 years old: 1-2 mg PO 12 hourly 2-5 years old: 1 mg PO 4-6 hourly Max dose: 6 mg/day 6-12 years old: 2 mg PO 4-6 hourly Max dose: 12 mg/day Extended-release: 6-11 years old: 4 mg PO 12 hourly	Regular-release: 4 mg PO 4-6 hourly Max dose: 24 mg/day Extended-release: 8-12 mg PO 12 hourly
Clemastine	1-3 years old: 0.25-0.5 mg PO 12 hourly 3-6 years old: 0.5 mg PO 12 hourly 6-12 years old: 0.5-1 mg PO 12 hourly	1 mg PO 12 hourly Max dose: 6 mg/day
Cyproheptadine	2-6 years old: 2 mg PO 8-12 hourly Max dose: 12 mg/day 7-14 years old: 4 mg PO 8-12 hourly Max dose: 16 mg/day	4 mg PO 8 hourly May increase as necessary up to Max dose: 32 mg/day
Dexchlorpheniramine¹	2-6 years old: 0.5 mg PO 4-6 hourly Max dose: 3 mg/day 6-12 years old: 1 mg PO 4-6 hourly Max dose: 6 mg/day	Regular-release: 2 mg PO 4-6 hourly Max dose: 12 mg/day Extended-release: 6 mg PO 12 hourly
Dimethindene	-	Regular-release: 1-2 mg PO 8 hourly
Diphenhydramine (Dimenhydrinate)	2-<6 years old: 6.25 mg PO 4-6 hourly 6-12 years old: 12.5-25 mg PO 4-6 hourly >12 years old: 25-50 mg PO 6-8 hourly	25-50 mg 6-8 hourly Max dose: 300 mg/day
Homochlorcyclizine	-	10-20 mg PO 8 hourly
Hydroxyzine	6 months-6 years old: Initial dose: 5-15 mg/day in divided doses Max dose: 50 mg/day in divided doses >6 years old: Initial dose: 15-25 mg/day in divided doses Max dose: 100 mg/day in divided doses	25 mg PO 24 hourly at night May increase to 25 mg PO 6-8 hourly
Mebhydrolin napadisylate	<2 years old: 50-100 mg/day PO in divided doses 2-5 years old: 50-150 mg/day PO in divided doses 5-10 years old: 100-200 mg/day PO in divided doses >10 years old: 100-300 mg/day PO in divided doses	100-300 mg/day PO
Mequitazine	5 mL/10 kg body weight/day PO	5 mg PO 12 hourly
Oxatomide	Initial dose: 0.5 mg/kg PO 12 hourly Optimal dose: 0.5-1 mg/kg PO 12 hourly	30 mg PO 12 hourly
Pheniramine	5-10 years old: 22.5 mg PO 8 hourly >10 years old: (syrup) 15-30 mg PO 8-12 hourly or (tab) 45 mg PO 8 hourly Max dose: 3 mg/kg/day	45 mg PO 8 hourly Max dose: 3 mg/kg/day
Piprinhydrinate	1.5 mg PO 8 hourly	3-6 mg PO 8 hourly
Promethazine	2-5 years old: 5-15 mg/day PO or 5 mg PO 12 hourly >5-10 years old: 10-25 mg PO 24 hourly or 5-10 mg PO 12 hourly Max dose: 25 mg/day	Initial dose: 10 mg PO 12 hourly or 25 mg PO 24 hourly at night Max dose: 20 mg PO 8 hourly
Second Generation
Acrivastine	>12 years old: 8 mg PO 8 hourly	8 mg PO 8 hourly	Adverse Reactions Cause little or no drowsiness and antimuscarinic effect as compared to first generation antihistamines Cetirizine may cause higher incidence of drowsiness as compared with other second generation antihistamines Special Instructions Use with caution in patients who need mental alertness (eg driving or using machineries), may rarely affect performance of skilled task Use with caution in patients with hepatic or renal impairment, epilepsy, and in the elderly
Cetirizine	6 months- 1 year: 2.5 mg PO 24 hourly 1-2 years old: 2.5 mg PO 12 hourly 2-6 years old: 5 mg PO 24 hourly or 2.5 mg PO 12 hourly 6-12 years old: 10 mg PO 24 hourly or 5 mg PO 12 hourly	10 mg PO 24 hourly
Desloratadine	2-5 years old: 1.25 mg PO 24 hourly 6-11 years old: 2.5 mg PO 24 hourly	5 mg PO 24 hourly
Ebastine	>6 years old: 5 mg PO 24 hourly	10-20 mg PO 24 hourly
Fexofenadine	6 months-<2 years old: 15 mg PO 12 hourly 2-11 years old: 30 mg PO 12 hourly	Regular-release: 60 mg PO 12 hourly Extended-release: 120-180 mg PO 24 hourly
Ketotifen fumarate (Ketotifen hydrogen fumarate)	1 mg PO 12 hourly	1 mg PO 12 hourly or 1 mg PO 24 hourly in the evening
Levocetirizine	6 months-5 years old: 1.25 mg PO 24 hourly 6-11 years old: 2.5 mg PO 24 hourly Max dose: 2.5 mg/day ≥12 years old: 5 mg PO 24 hourly Max dose: 5 mg/day	5 mg PO 24 hourly Max dose: 5 mg/day
Loratadine¹	2-12 years old: >30 kg: 10 mg PO 24 hourly ≤30 kg: 5 mg PO 24 hourly	10 mg PO 24 hourly

¹Combination with corticosteroids are available. Please see the latest MIMS for specific formulations and prescribing information.

Corticosteroids (Systemic)

Drug	Dosage	Remarks
Dexamethasone	0.5-10 mg PO 24 hourly or 0.4-20 mg IM/slow IV	Adverse Reactions Ophthalmological effects (increased intraocular pressure, visual disturbances); GI effects (acute pancreatitis, peptic ulcer with possible perforation and hemorrhage); Other effects (fluid and electrolyte disturbance, muscle weakness, osteoporosis, cushingoid state, growth retardation, menstrual irregularities, manifestations of latent DM, impaired wound healing, convulsion and increased intracranial pressure with papilledema) Special Instructions Contraindicated in patients with systemic fungal infection Use with caution in patients with CHF, DM, chronic renal failure, hypertension, GI diseases, recent intestinal anastomoses, osteoporosis, infectious diseases, myasthenia gravis, ocular herpes simplex, quiescent TB Risk of posterior subcapsular cataracts, glaucoma with possible damage to optic nerves and enhanced establishment of secondary ocular infections due to fungi or viruses upon prolonged use
Hydrocortisone	100-500 mg IV over 30 seconds-10 minutes May be repeated 2-6 hourly
Methylprednisolone	4-48 mg/day PO given in divided doses or 10-40 mg IM/IV
Triamcinolone	4-48 mg/day PO

Corticosteroids (Topical)

Drug	Available Strength	Dosage	Remarks
Very Potent			Application Once-twice daily applications are recommended for most agents. More frequent administration may be necessary for palms and soles of feet Every other day or weekend application has been used to treat chronic conditions Length of cream/oint scqueezed from tube can be measured by finger tip unit (FTU) which is tip of adult index finger to 1st crease 1 FTU (approximately 500 mg) is sufficient to cover 2 times the size of flat adult hand Recommended use of very potent agents for 1-2 weeks (max 3 weeks) following with weaker potency preparations Adverse Reactions The more potent the agent, the more chance of adverse reactions Local effects: Thinning of skin which may be restored after stopping treatment, worsening of underlying infection, contact dermatitis, acne at site of application, hypopigmentation which may be reversible, irreversible telangiectasia and striae atrophicae Systemic effects: Absorption through the skin can cause pituitary-adrenal-axis suppression, growth retardation, hypertension and Cushing's syndrome Absorption is increased by thin and/or raw skin, intertriginous areas or occlusion Absorption is more likely when used over very large areas and in children Special Instructions Mildly potent preparations are preferred for face and intertriginous areas Very potent agents should not be used in infants <1 years old Moderately potent and potent agents will rarely cause side effects if used for <3 months (except if used on face or intertriginous areas) Intermittent therapy is usually preferable to long-term continuous therapy Mildly potent agents will rarely cause side effects Intermittent therapy is usually preferable to long-term therapy especially if large areas are treated
Clobetasol propionate	0.05% cream, gel, ointment shampoo	Apply 12-24 hourly
Halcinonide	0.1% ointment, cream, lotion	Apply 8-12 hourly
Halobetasol propionate	0.5% ointment, cream	Apply 12-24 hourly
Potent
Amcinonide	0.1% cream, lotion, ointment	Apply 8-12 hourly
Beclometasone dipropionate¹	0.025% cream	Apply 8-24 hourly
Betamethasone dipropionate¹	0.05% cream, ointment, solution 0.064% cream, ointment, solution	Apply 8-24 hourly
Betamethasone valerate¹	0.025% cream 0.05% cream 0.06% cream 0.1% cream, lotion, ointment, solution	Apply 8-24 hourly
Desoximetasone (Dosoxymetasone)	0.05% gel 0.025% cream, ointment	Apply 8-24 hourly
Diflorasone diacetate	0.05% ointment, cream	Apply 8-24 hourly
Diflucortolone valerate¹	0.1% cream, fatty ointment, ointment	Apply 8-24 hourly
Fluclorolone acetonide	0.02% cream, ointment	Apply 12-24 hourly
Flucinolone acetonide¹	0.01% cream, ointment 0.025% cream, gel, ointment 0.2% cream	Apply 8-24 hourly
Fluocinonide	0.05% cream, lotion, ointment	Apply 6-12 hourly
Fluocinonide	0.1% cream	Apply 24 hourly
Fluocortolone/ Fluocortolone caproate	0.25%/0.25% ointment	Apply 12-24 hourly
Fluticasone propionate	0.005% ointment 0.05% cream	Apply 12-24 hourly
Halometasone	0.05% cream, ointment	Apply 12-24 hourly
Hydrocortisone aceponate	0.127% cream	Apply 12-24 hourly
Methylprednisolone aceponate	0.1% cream, ointment	Apply 24 hourly
Mometasone furoate	0.1% cream, fatty ointment, gel, lotion, ointment	Apply 24 hourly
Prednicarbate	0.25% cream	Apply 12-24 hourly
Moderately Potent
Alclometasone dipropionate	0.05% cream, ointment	Apply 8-12 hourly
Clobetasone butyrate	0.05% cream, ointment	Apply up to 6 hourly
Desonide	0.05% cream, lotion, ointment	Apply 6-12 hourly
Flumetasone	0.02% cream, lotion, ointment	Apply 8-12 hourly
Fluprednidene acetate	0.1% cream	Apply 12-24 hourly
Flurandrenolide	0.05% cream, ointment, lotion 0.25% cream, ointment	Apply 8-12 hourly
Hydrocortisone butyrate	0.1% cream, ointment, solution	Apply 6-12 hourly
Triamcinalone acetonide¹	0.02% cream 0.1% cream, lotion, ointment, scalp lotion, solution 0.2% cream 0.5% cream	Apply 6-12 houly
Mildly Potent
Hydrocortisone¹	1% cream, lotion, ointment 2.5% cream, lotion	Apply 6-24 hourly
Prednisolone	0.5% cream	Apply 8-24 hourly

¹Various combination preparations are available. Please see the latest MIMS for specific formulations and prescribing information.

Emollients, Cleansers, and Skin Protectives (Oral)

Drug

Dosage

Remarks

Alitretinoin

10-30 mg PO 24 hourly for 24 weeks

Adverse Reactions

CNS effects (headache, dizziness); Metabolic effects (increased levels of triglycerides and cholesterol, raised liver enzymes, decreased thyroid hormone levels); Hematologic effects (increased blood platelets, decreased red blood cells and white blood cells); Ophthalmologic effects (conjunctivitis, eyelid inflammation); Dermatologic effects (skin dryness, dry and inflamed lips, skin redness, itchy skin rash, inflamed skin, hair loss); Other effects (tinnitus, flushing, hypertension, nausea and vomiting, dry mouth, muscle and joint pain, fatigue)

Special Instructions

Contraindicated in patients with hypersensitivity to Alitretinoin, other retinoids (eg Isotretinoin), peanut or soya; high cholesterol or triglycerides, thyroid disease, hypervitaminosis A, liver and severe kidney disease; concomitant use of tetracycline or other retinoids; pregnancy and lactation
Do not donate blood during treatment and for 1 month after discontinuation
Immediately discontinue if any kind of mental health problems develops or if signs of intracranial hypertension or bloody diarrhea occurs
Monitor patient's sight, minimize sunlight exposure and avoid sun lamps and cut down on intensive physical exercise
Women must use effective contraception 1 month before, during, and 1 month afterwards

Emollients, Cleansers, and Skin Protectives (Topical)*

Drug	Available Strength	Indication	Administration
Allantoin	Cream; lotion; wash	Dry or sensitive skin Anti-inflammatory	Apply as needed
Arginine	Cream; lotion; wash	Helps increase skin hydration	Apply as needed
Ceramide	Cream; bar; lotion; ointment; wash	Dry or sensitive skin Symptomatic relief of mild to moderate atopic dermatitis and skin rashes	Use as soap substitute Moisturizer and/or for treatment: Apply 8-12 hourly Bath: Use as liquid cleanser
Dexpanthenol	5% ointment	Diaper rash Dry or damaged skin	Apply once or as needed
Dimeticone	Cream; lotion; ointment; shampoo	Helps relieve, repair, and protect very dry and damaged skin skin Helps increase skin moisture and enhance skin flexibility, softness and smoothness Helps provide moisture, relieve itch and irritation, soothes dry and sensitive scalp	Massage onto skin in the morning and at night after shower or as needed Shampoo: Massage all over wet scalp/hair for 3-5 minutes then rinse off thoroughly
Glycerin (Glycerine, Glycerol)	Soap; wash; cream; lotion	Cleansing treatment for ichthyosis xerosis, dry sensitive skin areas, pruritus hiemalis, atopic or infantile eczema, allergic dermatitis, soap-intolerant skin areas, sun-damaged skin, infant and elderly skin Helps relieve itching and flushing in dry skin, sensitive skin	Use as often as required
Glycyrrhetinic acid (Glyerrhetinic acid, Enoxolene, Potassium glycyrrhetinate, Glycyrrhetic acid)	2% cream; 2% lotion	Moisturizes and reduces the sensitivity of inflamed tissue Helps relieve burning, itching, and pain Enhances skin's healing process	Apply to affected area 12 hourly or as needed
Hyaluronic acid (Na hyaluronate)	Cream; lotion	Manages and relieves itching, burning, and pain caused by different dermatoses; relieves dry and waxy skin Promotes wound healing	Apply to affected area 8 hourly and massage gently
Hydroxypalmitoyl sphinganine (Dihydroceramide)	Lotion; wash	Relief of very dry skin and itchy skin Moisturizer with sunscreen for oily blemished skin, as an adjunct to acne treatment	Lotion: Apply immediately after bathing as often as needed Wash: Apply to wet skin and amssage into a lather
Lactic acid	Liquid soap; wash	Antiseptic in topical dermatitis, seborrheic dermatitis, eczema, pruritus, mycosis, intertrigo and seborrhea Diaper rash, infant hygiene	Use as soap substitute
Lactic acid	Crean; lotion	Emollient moisturizer for dry skin, xerosis, senile pruritus, atopic dermatitis and chafing	Apply as required
Liquid paraffin	6% cream; 7.5% bar; 63.4% topical emulsion; 70% topical gel; 85% bath oil	Treatment for ichthyosis xerosis, dry skin associated with dermatitis, eczema, geriatric therapy, chronic psoriasis, winter itch (pruritus hiemalis)	Bar: Work up a rich lather with little water and cleanse affected areas. Refrain from rinsing excessively to allow a thin film of oil to remain on the skin. Pat dry Bath: Apply a small amount to wet skin after normal cleansing and massage in gently. Rinse off Cream: Apply onto affected area and rub in well Shower: Apply to the whole affected area while skin is wet. Then rub and massage gently. Rinse off
Panthenol	Cream; lotion	For sensitive and dry skin Prevents skin irritation	Use as a soap substitute
Paraffin (Mineral oil)	Bar; cream; emollient; gel; shower	Itchy, irritated, dry, sensitive skin Controls or prevents progression of burning, redness, and itching induced by atopic dermatitis	Cream: Apply to the affected area and rub in well. Use as often as required. It is particularly beneficial if applied immediately after washing to counteract loss of essential oils from the skin Emollient: Add to bath water or rub onto wet skin
Piroctone olamine	Cream; lotion	Helps manage and relieve dry waxy skin by maintaining moist skin environment which enhances the healing process	Apply to affected area 8 hourly or as needed
Saccharide isomerate	Cream; lotion; ointment; cleanser	Symptomatic relief of dry skin secondary to chronic dermatitis, eczema, psoriasis, ichthyosis	Apply 12 hourly or as often as needed especially after shower Cleanser: Apply to wet skin and massage over face and whole body then rinse off and pat dry
Shea butter (Butyrospermum parkii extract)	Body butter; body wash; cream; lotion	Moisturizes and helps relieve burning, itching, and pain	Body butter: Apply to skin liberally as needed Body wash: Apply with a cleansing puff or sponge Cream/lotion: Apply to affected area 6-8 hourly and as needed
Telmesteine	Cream; lotion	Moisturizes and reduces the sensitivity of inflamed tissue Helps relieve burning, itching, and pain Enhances skin's healing process	Apply to affected area 12 hourly
Urea	10%, 20% cream; lotion; shampoo	Emollient for hyperkeratotic or excessively dry skin conditions (eg xerosis, contact irritant dermatitis, pruritus)	Apply sparingly and rub into the affected area 8-12 hourly and as required Shampoo: Use daily as needed
Vitamin A	Cream; ointment	Diaper rash, chafing, minor burns, sunburn, small wounds and dry skin Helps relieve burning, itching, and pain Enhances skin's healing process	Apply 8-12 hourly
Vitamin E	Cream; lotion; wash	Dry skin Protects skin from UV radiation	Apply as needed
Vitis vinifera seed extract (Grape seed extract)	Cream; lotion	Promotes healing with its antioxidant and free-radical scavenging activity Protects impaired skin barrier	Apply 24 hourly
Zinc oxide	7.5%, 10%, 32%, 310 mg/g cream; 40%, 200 mg/g ointment; topical powder	Prevention and treatment of diaper rash by preventing wetness from coming into direct contact with the skin Promotes healing of minor skin irritations, non-infected wounds and burns Soothes and protects in eczema and slight excoriation	Infants: Apply at each diaper change especially at bedtime Adults: Use daily on skin, affected areas and into skin, affected areas, and into skin folds, smooth onto areas prone to chafing

*Combination with other emollients are available. Please see the latest MIMS for specific formulations and prescribing information.

Immunosuppressants (Oral)

Drug	Dosage	Remarks
Ciclosporin (Cyclosporin A, Cyclosporine)	2.5-5 mg/kg/day PO divided 12 hourly for a max of 4 weeks May increase to max dose of 5 mg/kg/day if necessary after 2 weeks	Adverse Reactions CNS effects (headache, tremor, paresthesia, muscle cramps, myalgia); CV effects (hypertension, hyperlipidemia, edema); GI effects (abdominal pain, diarrhea, nausea, gingival hyperplasia, pancreatitis); Hepatic effect (hepatotoxicity); Renal effects (nephrotoxicity, electrolyte disturbances); Other effects (hypertrichosis, hyperuricemia, rashes, anemia) Special Instructions Avoid in patients with renal dysfunction, uncontrolled hypertension, uncontrolled infections, persistently raised creatinine, malignancy Use with caution in patients with hyperuricemia, increased risk of benign intracranial hypertension Monitor renal and hepatic function, BP and serum electrolytes, and lipdids regularly Vaccination with live-virus vaccines while on therapy is not recommended
Janus Kinase (JAK) Inhibitors
Abrocitinib	100 mg PO 24 hourly May increase to up to 200 mg PO 24 hourly CYP2C19 poor metabolizer: 50 mg PO 24 hourly May increase to up to 100 mg PO 24 hourly	Adverse reactions GI effects (nausea and vomiting, gastroenteritis, abdominal discomfort); CNS effects (headache, dizziness); Other effects (nasopharyngitis, oropharyngeal pain, herpes simplex, herpes zoster, UTI, influenza, fatigue, acne, impetigo, contact dermatitis, hypertension, thrombocytopenia, increased blood creatinine phosphokinase) Special Instructions Avoid antiplatelet therapies except for low-dose Aspirin (≤81 mg/day) during the first 3 months of treatment Avoid in patients with active serious infection; discontinue treatment if a serious or opportunistic infection occurs Evaluate and test patients for TB prior to starting therapy; treat latent TB prior to use Lab monitoring is recommended due to potential changes in platelets, lymphocytes, and lipids Avoid use of live-vaccines prior to, during, and immediately after Abrocitinib treatment
Baricitinib	2-4 mg PO 24 hourly Adjust dose depending on the patient's response	Adverse reactions Respiratory effects (upper respiratory infection [URTI], pulmonary embolism); GI effects (nausea, abdominal pain); Other effects (weight gain, headache, rash, elevated liver enzymes, acne, hypercholesterolemia) Special Instructions Avoid use with other biologic disease-modifying antirheumatic drugs (bDMARDs) or strong immunosuppressants (eg Azathioprine, Ciclosporine) Use with caution in patients with active or recurrent infections (eg bacterial, fungal, viral), deep venous and arterial thrombosis, pulmonary embolism Screen patients for TB prior to treatment
Upadacitinib	Children ≥12 years old with weight 40 kg and adults <75 years old: 15 mg PO 24 hourly May increase to up to 30 mg PO 24 hourly Adults ≥65 years old: 15 mg PO 24 hourly	Adverse reactions Respiratory effects (URTI, cough); GI effects (nausea, abdominal pain); Other effects (acne, folliculitis, herpes simplex, herpes zoster, influenza, headache, hypersensitivity, pyrexia, increased weight, myalgia, fatigue, neutropenia, increased blood creatine phosphokinase) Special Instructions Use with caution in patients with history of serious or opportunistic infections, risk factors for CV disorders, lymphomas and other malignancies, high risk of thromboembolic events Use in patients with severe hepatic impairment is not recommended Screen patients for tuberculosis, viral hepatitis, and monitor for reactivation prior to initiation Perform periodic skin exam in patients at increased risk of skin cancer

Immunosuppressant (Topical)

Drug

Strength

Dosage

Remarks

Ruxolitinib

1.5% cream

Apply thin layer to affected areas 12 hourly for up to 20% body surface area (BSA)
Max dose: 60 g/week

Adverse Reactions

Respiratory effects (nasopharyngitis, bronchitis, rhinorrhea); Dermatologic effects (folliculitis, urticaria); Other effects (diarrhea, ear infection, increased eosinophil count, tonsillitis)

Special Instructions

Avoid use in immunocompromised patients, and in patients with active, serious infection
Avoid concomitant use with other JAK inhibitors or potent immunosuppressants (eg Azathioprine, Ciclosporin)
Minimize exposure to sunlight or UV light
Monitor for signs and symptoms of infection regularly
Perform CBC regularly, and periodic skin exam in patients at increased risk of skin cancer

Other Dermatologicals (Parenteral)

Drug	Dosage	Remarks
Dupilumab	Initial dose: 600 mg (two 300 mg injection) SC followed by 300 mg SC every other week	Adverse Reactions Local effect (injection site reaction); Ophthalmologic effects (conjunctivitis, allergic conjunctivitis, eye pruritus, blepharitis); Other effects (oral herpes, eosinophilia, headache) Special Instructions Initial two SC injection should be consecutively administered into different injection sites Use with caution in atopic dermatitis patients with comorbid asthma, patients with hepatic impairment or severe renal impairment Treat patients with pre-existing helminth infections prior to initiation of treatment
Interleukin-13 Antagonists
Lebrikinumab	Initial dose: 500 mg SC (given as two 250 mg injections) at week 0 and week 2 followed by 250 mg SC once every other week up to 16 weeks or later, when adequate clinical response is achieved Maintenance dose: 250 mg SC once every 4 weeks	Adverse Reactions Ophthalmologic effect (conjunctivitis); Other effects (injection site reaction, herpes zoster) Special Instructions Any pre-existing helminth infections should be treated before initiation of treatment Contraindicated in patients with known hypersensitivity to Lebrikizumab Avoid use of live vaccines during treatment
Tralokinumab	Initial dose: 600 mg SC (given as four 150 mg injections) followed by 300 mg (given as two 150 injections) once every other week	Adverse Reactions Respiratory effect (URTI); Ophthalmologic effects (allergic conjunctivitis, keratoconjunctivitis); Other effect (local site reaction) Special Instructions Any pre-existing helminth infections should be treated before initiation of treatment Contraindicated in patients with known hypersensitivity to Tralokinumab Avoid use of live vaccines during treatment

Other Dermatologicals (Topical)

Drug	Available Strength	Dosage	Remarks
Calcineurin Inhibitors
Pimecrolimus	1% cream	Adults and children ≥3 months: Apply a thin layer to affected skin 12 hourly Rub in gently and completely	Adverse Reactions Local effects (burning, sensation of warmth which usually decreases with continued use, application site reactions); Other effects (bacterial and viral infections) Special Instructions Do not apply to areas of acute cutaneous viral infections; should not be used with occlusive dressing Pimecrolimus: Bacterial and fungal infections should be treated appropriately. If infection does not resolve, discontinue until infection clears Tacrolimus: If lymphadenopathy occurs, the cause should be investigated and if there is no clear cause, Tacrolimus should be discontinued Clinical cutaneous infections should be cleared before application; should not be used with occlusive dressing In long-term treatment, should be used at first sign of atopic dermatitis to prevent flare-up and continued as long as signs and symptoms persist If no improvement within 6 weeks, patient should be re-evaluated Patients should minimize or avoid natural or artificial sunlight
Tacrolimus	0.03% 0.01% ointment	Children 2-15 years of age: Apply a thin layer of 0.03% ointment to affected skin 12 hourly Adults and children ≥16 years of age: Apply a thin layer of 0.03% or 0.1% ointment to affected area 12 hourly Rub in gently and completely
Others
Crisaborole	2% ointment	Adults and children ≥3 months old: Apply a thin layer to affected area 12 hourly Maintenance dose: Reduce dose to 24 hourly once clinical effect has been achieved	Adverse Reactions Local effects (burning, stinging, application site pain); Respiratory effects (URTI, cough, nasopharyngitis); Other effect (pyrexia) Special Instructions Not to be used for >28 days Use with caution in patients with hepatic or renal impairment

Topical Antihistimine or Antipruritics*

Drug	Available Strength	Dosage	Remarks
Pine tar	2.3% bath oil; 1.6% gel	Bath: Add 10-15 mL to a ward bath, bathe for 5-10 minutes (Infant: 3 mL) Shower: Apply undiluted directly on wet skin, rinse gently	Special Instructions Avoid contact with eyes

*Combination with emollients are available. Please see the latest MIMS for specific formulations and prescribing information.

Atopic Dermatitis Drug Summary