Atopic dermatitis: Topical antihistamines recommendations

  • The use of topical antihistamines for the treatment of patients with atopic dermatitis is not recommended because of the risk of absorption and of contact dermatitis.
Level of Evidence: II Strength of Recommendation: B  

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Topical antihistamines have been tried for the treatment of AD but unfortunately have demonstrated little utility and are not recommended. Studies investigating topical doxepin have demonstrated a short-term decrease in pruritus in some cases, but with no significant reduction in disease severity or control. Treatment has local side effects, particularly stinging and burning, and can also cause sedation.115,116 There are multiple reports of allergic contact dermatitis secondary to the use of topical doxepin; however, the specific incidence of this outcome cannot be established with certainty based on the available data.117 There are no controlled studies on the use of topical diphenhydramine for AD. It may also cause allergic or photoallergic contact dermatitis.118 Widespread application, use on broken skin, and/or combined use with oral diphenhydramine are not advised because of risk for systemic toxicities such as toxic psychosis (e.g., hallucinations, delirium), particularly in children.119,120

References

  1. Berberian BJ, Breneman DL, Drake LA, Gratton D, Raimir SS, Phillips S, et al. The addition of topical doxepin to corticosteroid therapy: an improved treatment regimen for atopic dermatitis. Int J Dermatol 1999;38:145-8.
  2. Drake LA, Fallon JD, Sober A. Relief of pruritus in patients with atopic dermatitis after treatment with topical doxepin cream: the doxepin study group. J Am Acad Dermatol 1994; 31:613-6.
  3. Bonnel RA, La Grenade L, Karwoski CB, Beitz JG. Allergic contact dermatitis from topical doxepin: Food and Drug Administration’s postmarketing surveillance experience. J Am Acad Dermatol 2003;48:294-6.
  4. Horio T. Allergic and photoallergic dermatitis from diphenhydramine. Arch Dermatol 1976;112:1124-6.
  5. Food and Drug Administration; Department of Health and Human Services. Labeling of diphenhydramine-containing drug products for over-the-counter human use: final rule. Fed Regist 2002;2:72555-9.
  6. Food and Drug Administration; Department of Health and Human Services. Labeling of diphenhydramine-containing drug products for over-the-counter human use: proposed rules. Fed Regist 1997;62:45767-74. 

Navigate section 2 of the AD guideline: Topical therapy   

Citation note 

When referencing this guideline in a publication, please use the following citation: Eichenfield LF, Tom WL, Berger TG, Krol A, Paller AS, Schwarzenberger K, et al. Guidelines of care for the management of atopic dermatitis: section 2. Management and treatment of atopic dermatitis with topical therapies. J Am Acad Dermatol. 2014 Jul;71(1):116-32.

 


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