About Systemic Medications Commonly Used for Atopic Dermatitis

In treating children with atopic dermatitis, physicians sometimes use a variety of oral medications to manage symptoms. Commonly used medications include antihistamines, leukotriene antagonists, steroids, immunosuppressants, antibiotics, intravenous immunoglobulin, and anti-IgE monoclonal antibodies. For more severely affected children, whose skin involvement might be as high as 60% to 70%, topical ointments alone may not be sufficient to cover all affected areas, thus necessitating the use of systemic medications to help control these symptoms.

Usage of Antihistamines

In treating atopic dermatitis, oral antihistamines are primarily used to alleviate itching. Based on the duration of action, antihistamines can be divided into short-acting and long-acting types. Short-acting antihistamines such as buclizine, dexchlorpheniramine maleate, and cyproheptadine are more effective at relieving itching but can cause side effects like dry mouth and drowsiness. On the other hand, long-acting antihistamines such as loratadine, desloratadine, levocetirizine, and fexofenadine have fewer side effects but are somewhat less effective at relieving itch.

Application of Leukotriene Antagonists

Leukotriene antagonists like Singulair can be prescribed to simultaneously manage allergic symptoms when the patient also suffers from asthma. These drugs are mainly used for treating mild to moderate asthma and have also been shown to have a supplementary improvement effect on atopic dermatitis. However, due to health insurance payment restrictions, non-asthma patients would need to pay out-of-pocket.

The Appropriate Circumstances for Systemic Steroids

During the acute phase of atopic dermatitis, systemic steroids like Prednisolone, Solu-Cortef, and Solu-Medrol can rapidly control symptoms. However, steroids have side effects, so it is crucial to manage the dosage and duration of use to avoid long-term adverse effects.

Choices and Considerations for Immunosuppressants

Immunosuppressants such as cyclosporine, Azathioprine, Methotrexate, and Mycophenolate mofetil can inhibit overly active immune responses in the treatment of atopic dermatitis. These drugs can cause side effects like bone marrow suppression and require regular monitoring during use.

Intravenous Immunoglobulin and Anti-IgE Antibodies

Intravenous immunoglobulin and anti-IgE antibodies such as Xolair represent high-end treatment options for specific immune diseases and severe allergic reactions. These medications are expensive and not covered by health insurance, usually requiring out-of-pocket payment.

Use of Antibiotics

In cases of severe infections caused by atopic dermatitis, appropriate systemic antibiotics can effectively control the infection, reducing further skin inflammation caused by bacteria. However, excessive use may lead to resistance, so careful use is necessary.
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