Atopic Dermatitis (Pediatric) Drug Summary

Drug	Dosage	Remarks
Dexamethasone	0.02-0.3 mg/kg/day PO or 0.6-9 mg/m2/day PO divided 6-12 hourly	Adverse Reactions Ophthalmologic 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	Individualized dose Minimum dose: 25 mg/day IV/IM Maximum dose: 15 mg/kg
Methylprednisolone	4-48 mg/day PO given in divided doses or 10 to 40 mg IM/IV
Triamcinolone	4-12 mg/day PO

Drug	Available Strength and/or Preparations	Indication	Administration
Ceramide	Bar; cream; lotion	Dry/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
Chamomile (Matricaria recutita, Chamomilla recutita flower extract)	Bath oil; cream; shampoo; wash	Sensitive skin Cleanses sensitive skin and scalp without drying Stabilizes skin moisture and lipid content, preventing scaling and drying out	Use as soap substitute Bath oil: Apply 10-20 mL directly to whole body, rub gently for 5 minutes then rinse with lukewarm water Cream: Apply to affected area Wash: Massage all over wet skin/hair then rinse off thoroughly
Dexpanthenol	2-5% cream, ointment, solution	Diaper rash Dry/damaged skin	Apply once or as needed (after each diaper change)
Dimeticone	Cream; lotion; shampoo	Helps relieve, repair and protect very dry and damaged skin Helps increase skin moisture and enhance skin flexibility, softness and smoothness Helps provide moisture, relieve itch and irritation, and 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, leave for 3-5 minutes then rinse off thoroughly
Glycerin	Cream; lotion; soap; wash	Cleansing treatment for dry sensitive skin areas, xerosis, atopic or infantile eczema, ichthyosis, pruritus hiemalis, soap-intolerant skin areas, sun-damaged skin, allergic dermatitis, infant/elderly skin Helps relieve itching and flushing in dry, sensitive skin	Use as often as required
Glycyrrhetinic acid (Enoxolone, Glycyrrhetic acid)	Cream; lotion	Treatment of non-infective inflammatory disorders of the skin Symptomatic relief of various types of dermatoses	Apply on affected area 8 hourly and massage gently
Hyaluronic acid (Na hyaluronate)	Cream; lotion	Symptomatic relief of various types of dermatoses For better wound healing	Apply on affected area 8 hourly and massage gently
Lactic acid	Liquid soap; wash	Antiseptic in topical dermatitis, eczema, pruritus, mycosis, intertrigo, and seborrheic dermatitis Diaper rash, infant hygiene	Use as a soap substitute
	Cream; lotion	Emollient moisturizer for dry skin, atopic dermatitis, senile pruritus, xerosis, and chafing	Apply as required
Liquid paraffin	7.5% bar; 85% bath oil; 6% cream; 63.4% emollient; 70% shower gel; 70% topical gel	Treatment for ichthyosis, xerosis, dry skin associated with dermatitis, eczema, geriatric therapy, chronic psoriasis, winter itch (pruritus hiemalis)	Bath: Add 1-3 capfuls to 8-inch bath water. Soak for 10-20 minutes Bar: Work up a rich lather with a little water and cleanse affected area. Refrain from rinsing excessively to allow a thin film of oil to remain on the skin. Pat dry Cream: Apply onto affected area and rub in well Emollient: Wet skin and rub in affected area; can also be used for bath Shower: Apply to the whole affected area while skin is wet. Then rub and massage gently. Rinse off
Paraffin (Mineral oil)	Bar; cream; emollient; gel; shower	Itchy, irritated, dry, sensitive skin	Cream: Apply to the affected area and rub in well. Use as often as required 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	Symptomatic relief of dry skin secondary to chronic dermatitis, eczema, psoriasis, ichthyosis	Apply 12 hourly or as often as needed especially after shower
Shea butter (Butyrospermum parkii extract)	Cream; lotion; wash	Nourishes and soothes skin in need of replenishment and moisture which makes the skin soft and supple	Apply 24 hourly
Telmesteine	Cream; lotion	Relieves dry, waxy skin by maintaining a moist skin environment, which is beneficial to the healing process Protects skin from epithelial damage Reduces harmful enzymes (eg elastase, collagenase, metalloproteinase)	Apply 8-24 hourly or as needed
Urea	10%, 20% cream; lotion; shampoo	Emollient for hyperkeratotic or excessive 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 24 hourly as needed
Vitamin A	Ointment	Diaper rash, chafing, minor burns, sunburn, small wounds and dry skin	Apply 8-12 hourly
Vitamin E	Cream; lotion; ointment	Dry skin	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%, 15%, 18.5%, 32%, 310 mg/g cream; 3.8%, 7.5%, 10%, 20%, 40%, 200 mg/g ointment; paste; 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	Apply as needed
*Combination with other emollients are available. Please see the latest MIMS for specific formulations and prescribing information.

Drug	Dosage	Remarks
Janus Kinase (JAK) Inhibitors
Abrocitinib	≥12 years old: 100 mg PO 24 hourly May increase to up to 200 mg PO 24 hourly	Adverse Reactions GI effects (nausea/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
Upadacitinib	≥12 years old, ≥30 kg: 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, lymphoma 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

Drug	Dosage	Remarks
Dupilumab	6 months-5 years old, 5-<15 kg: Initial dose: 200 mg SC Subsequent dose: 200 mg SC every 4 weeks 6 months-5 years old, 15-<30 kg: Initial dose: 300 mg SC Subsequent dose: 300 mg SC every 4 weeks 6-11 years old, 15-<60 kg: Initial dose: 300 mg SC on day 1, followed by 300 mg SC on day 15 Subsequent dose: 300 mg SC every 4 weeks, starting 4 weeks after day 15 dose 6-11 years old, ≥60 kg: Initial dose: 600 mg SC consecutively administered as 300 mg SC each in 2 different injection sites Maintenance dose: 300 mg SC every other week ≥12 years old, <60 kg: Initial dose: 400 mg SC consecutively administered as 200 mg SC each in 2 different injection sites Subsequent dose: 200 mg SC every other week ≥12 years old, ≥60 kg: Initial dose: 600 mg SC consecutively administered as 300 mg SC each in 2 different injection sites Subsequent dose: 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, facial redness) Special Instructions Use with caution in patients with helminth infections, asthma, severe renal impairment, hepatic impairment Treat patients with pre-existing helminth infection prior to initiation of treatment
Lebrikizumab	≥12 years old, ≥40 kg: Initial dose: 500 mg SC (given as two 250 mg injections) at week 0 and 2, followed by 250 mg SC every other week up to week 16 Maintenance dose: 250 mg SC every 4 weeks	Adverse Reactions Ophthalmologic effects (conjunctivitis, allergic conjunctivitis, dry eye); Other effect (injection site reaction) Special Instructions Rotate injection site with each injection Contraindicated in patients with known hypersensitivity to Lebrikizumab Avoid use of live and live attenuated vaccines during treatment Treat patients with pre-existing helminth infection prior to initiation of treatment
Nemolizumab	≥12 years old; in combination with topical corticosteroids and/or topical calcineurin inhibitors: Initial dose: 60 mg SC (given as two 30 mg injections) followed by 30 mg every 4 weeks Maintenance dose (after 16 weeks of treatment; for patients with clinical response): 30 mg SC every 8 weeks	Adverse Reactions CNS effects (headache, migraine headache); Musculoskeletal effects (arthralgia, myalgia); Other effect (urticaria) Special Instructions Contraindicated in patients with known hypersensitivity to Nemolizumab Use with caution in patients with pre-existing asthma Avoid use of live vaccines during treatment
Tralokinumab	≥12 years old: 600 mg SC (given as four 150 mg injections) followed by 300 mg (given as two 150 mg 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

Drug	Available Strength	Dosage	Remarks
Calcineurin Inhibitors
Pimecrolimus	1% cream	≥3 months old: Apply 12 hourly	Application Apply a thin layer to affected skin and rub in gently and completely Adverse Reactions Local effects: Burning, sensation of warmth which usually decreases with continued use, application site reactions (eg irritation, erythema, itching) Less common: Bacterial and viral infections Higher dose than used in humans, shortened time to skin tumor formation in animal photocarcinogenicity study Special Instructions Do not apply to areas of acute cutaneous viral infections Bacterial and fungal infections should be treated appropriately. If infection does not resolve, discontinue Pimecrolimus until infection clears 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 Should not be used with occlusive dressing Patients should minimize or avoid natural or artificial sunlight
Tacrolimus	0.03%, 0.1% ointment	2-15 years old: Apply 0.03% ointment 12-24 hourly to the affected areas ≥16 years old: Apply 0.03% or 0.1% ointment 12-24 hourly to the affected areas	Application Apply a thin layer to affected skin and rub in gently and completely Adverse Reactions Local effects: Burning, stinging, pruritus which usually decreases with continued use Less common: Bacterial and viral infections If lymphadenopathy occurs, the cause should be investigated and if no clear cause, Tacrolimus should be discontinued Higher dose than used in humans, shortened time to skin tumor formation in animal photocarcinogenicity study Special Instructions Do not apply to areas of acute cutaneous viral infections Clinical cutaneous infections should be cleared before application of Tacrolimus Continue treatment for 1 week after clearing of signs and symptoms of atopic dermatitis Should not be used with occlusive dressing Patients should minimize or avoid natural or artificial sunlight
Janus Kinase (JAK) Inhibitor
Ruxolitinib	1.5% cream	≥12 years old: Apply 12 hourly Max dose: 60 g/week	Application Apply a thin layer to affected skin Application area should not be >20% of total BSA Adverse Reactions Most common: Respiratory effects (nasopharyngitis, bronchitis, rhinorrhea, tonsillitis); Dermatologic effects (folliculitis, urticaria); Other effects (diarrhea, ear infection, eosinophilia) Special Instructions Contraindicated in patients with active hepatitis B or C, active serious infection including localized infection Use with caution in patients with chronic or recurrent infection, predisposed to infection If no improvement within 8 weeks, patient should be re-evaluated Periodic skin examination should be performed during and after therapy Monitor for signs and symptoms of infection during and after therapy Monitor complete blood count (CBC) regularly
Phosphodiesterase-4 Inhibitors
Crisaborole	2% ointment	≥3 months old: Apply 12 hourly	Application Apply a thin layer to affected skin and rub in gently and completely Adverse Reactions Local effect: Application site pain (eg mild transient burning or stinging) Less common: Urticaria, hypersensitivity reaction (eg swelling, erythema, severe pruritus), allergic contact dermatitis Special Instructions Monitor for signs of hypersensitivity reaction; discontinue use immediately if signs and symptoms of hypersensitivity occur
Difamilast	1% ointment	≥2 years old: Apply 12 hourly	Application Apply a thin layer to affected skin and rub in completely Adverse Reactions Most common: Respiratory effect (nasopharyngitis) Less common: Dermatologic effects (folliculitis, application site rash, contact dermatitis, molluscum contagiosum) Special Instructions Avoid using on infected skin
Roflumilast	0.05% cream	2-5 years old: Apply 24 hourly	Application Apply a thin layer to affected skin and rub in completely Adverse Reactions Most common: GI effects (nausea/vomiting, diarrhea); Respiratory effects (upper respiratory tract infection, rhinitis); Other effects (headache, conjunctivitis, application site pain) Special Instructions Contraindicated in patients with moderate to severe liver impairment (Child-Pugh B or C)
	0.15% cream	≥6 yr: Apply 24 hourly

Drug	Available Strength	Dosage	Remarks
Very Potent
Clobetasol propionate	0.05% cream, gel, ointment, scalp application	Apply 12-24 hourly	Application Once to twice daily applications are recommended for most agents. More frequent administration may be necessary for palms or soles of feet Every other day or weekend application has been used to treat chronic conditions Length of cream/ointment squeezed from tube can be measured by FTU which is tip of adult index finger to first crease 1 FTU (approximately 500 mg) is sufficient to cover 2x the size of flat adult hand Recommended use of very high potency agents is for 1-2 weeks (maximum 3 weeks) following with weaker potency preparations as the condition improves Adverse Reactions The more potent the agent, the more chance of adverse reactions Local effects: Thinning of skin which may or may not 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 atrophica 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 patients <1 year of age 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 continuous therapy especially if large areas are treated
Potent
Beclometasone dipropionate	0.05% cream, gel, lotion, ointment, solution; 0.064% cream, ointment, solution	Apply 8-24 hourly
Betamethasone dipropionate	0.025% cream 0.05% cream, ointment 0.064% cream, solution	Apply 12 hourly
Betamethasone valerate	0.01% cream; 0.0125% cream; 0.025% cream; 0.05% cream	Apply 12-24 hourly
	0.06% cream	Apply 24 hourly
	0.1% cream, lotion, ointment, solution	Apply 8-24 hourly
Desoximetasone (Desoxymetasone)	0.05% gel, ointment; 0.25% cream, ointment	Apply 12 hourly
Diflucortolone valerate	0.1% cream, fatty ointment, ointment 0.3% cream, ointment	Apply 8-24 hourly
Fluclorolone acetonide	0.025% cream	Apply 6-12 hourly
Fluocinolone acetonide	0.01% body oil, cream, ointment 0.025% cream, gel, ointment; 0.2% cream	Apply 6-12 hourly
Fluocinonide	0.05% cream, gel, lotion, ointment, solution	Apply 6-12 hourly
	0.1% cream	Apply 24 hourly
Fluocortolone/Fluocortolone caproate	0.25% cream, ointment	Apply 12-24 hourly
Fluticasone propionate	0.05% cream, lotion; 0.005% ointment	Apply 12-24 hourly
Halometasone	0.05% cream	Apply 12-24 hourly
Hydrocortisone aceponate	0.127% cream	Apply 24 hourly
Methylprednisolone aceponate	0.1% cream, lotion, 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, foam, gel, lotion, ointment	Apply 6-12 hourly
Flumetasone	0.02% ointment	Apply 8-12 hourly
Fluprednidene acetate	0.1% cream, ointment; 0.05% ointment	Apply 12-24 hourly
Hydrocortisone butyrate	0.1% cream, ointment, solution	Apply 8-24 hourly
Triamcinolone acetonide	0.1% cream, lotion, ointment, scalp lotion; 0.02% cream; 0.2% cream; 0.025% cream, lotion; 0.05% cream; 0.5% cream	Apply 6-12 hourly
Mildly Potent
Hydrocortisone	1% lotion, cream, ointment; 2.5% lotion	Apply 6-24 hourly
Prednisolone	0.5% cream	Apply 8-24 hourly

All dosage recommendations are for children with normal renal and hepatic function unless otherwise stated. 
Not all products are available or approved for above use in all countries. 
Products listed in the Drug Summary are based on indications stated in the locally approved product monographs. 
Please refer to local product monographs in Related MIMS Drugs for country-specific prescribing information.