Guidelines for the management of atopic dermatitis (eczema) for pharmacists

Box 1 Pharmacists' responsibilities for patients with atopic dermatitis Improving adherence through patient education Atopic dermatitis (AD) patient-friendly education: highlight the appropriate use of AD treatment, goals of therapy, AD triggers to avoid, when to see the physician and review of myths and misunderstandings in AD management Safety of topical corticosteroid (TCS): reassure patients that appropriate use of TCS can safely relieve symptoms without adverse effects Safety of topical calcineurin inhibitor (TCI): reassure patients that, to date, there is no substantial evidence to suggest TCIs are associated with increased cancer risk (including lymphomas) or systemic immunosuppression Basic skin care: reinforce the regular use of moisturizers and the avoidance of aggravating factors Pharmacists should work with their patients to create SMART (Specific, Measurable, Attainable, Relevant and Time-based) goals as a means of providing patients with a structured framework to set treatment objectives for themselves in managing their AD. Lotions are less preferable in the management and prevention of AD because of their higher water-to-oil content. [...]the benefit of topical ceramides over other moisturizers is not well established, given the lack of head-to-head studies at this time. Table 1 Outline of available treatments in atopic dermatitis Topical Phototherapy and systemic therapy Class: Corticosteroids Examples[*]:Low-potency * Hydrocortisone acetate 1% cream/ointment* Desonide 0.05% cream/ointmentMid-potency * Betamethasone valerate 0.05% or 0.1% cream/ointment* Mometasone furoate 0.1% cream* Hydrocortisone valerate 0.2% cream/ointmentHigh-potency * Fluocinonide 0.05% cream/ointment/gel* Mometasone furoate 0.1% ointment* Desoximetasone 0.25% cream/ointment/gelVery-high potency * Betamethasone dipropionate glycol 0.05% ointment* Clobetasol propionate 0.05% cream/ointment* Halobetasol propionate 0.05% cream/ointment Class: Corticosteroids Example:PrednisoneClass: Calcineurin inhibitor Example:Cyclosporine AClass: Anti-metabolites Examples:MethotrexateAzathioprineMycophenolate mofetil Class: Calcineurin inhibitors Examples: Tacrolimus 0.03% ointment Tacrolimus 0.1% ointment Pimecrolimus 1% cream Phototherapy Example: * Narrow-band UVB (311 nm) * Broad-band UVB * Psoralen + UVA photochemotherapy * For a comprehensive list of topical corticosteroids, organized by potency, available in Canada and available dosage forms, contact the Eczema Society of Cana