Treatment

  • Nutritional assessment
  • Management of fluid and electrolyte imbalances
  • Prevention of hypothermia
  • Treatment of secondary infections

  • Sedating oral antihistamines for severe pruritus
  • Bland emollient
  • Low potency corticosteroid ointment

  • Rule out other causes
  • Topical 
    • open wet dressings 
    • bland emollients 
    • low potency corticosteroid ointments
    • high potency corticosteroid ointments only for lichenification 
  • Systemic 
    • Oral antihistamines
    • Prednisone 1-2 mg/kg/day initially, then 0.5 mg/kg/day or less for maintenance 
    • Taper slowly to avoid rebound
    • If refractory: Cyclosporine 5 mg/kg/day initially then 1-3 mg/kg/day), methotrexate, azathioprine, mycophenolate mofetil 
  • Best empiric treatment is methotrexate

  • Discontinue all non-essential drugs and suspected drugs
  • Topical (as above)
  • Prednisone (as above) or IVIg for severe cases

  • Methotrexate
  • Acitretin
  • Cyclosporine
  • Biologics

  • Prednisone (see above)
  • Cyclosporine (see above)
  • Methotrexate
  • Azathioprine
  • Mycophenolate mofetil
  • Dupilumab

  • Isotretinoin/acitretin
  • Methotrexate 
  • TNF alpha inhibitors 
  • Ustekinumab 
  • Secukinumab 
  • Immunosuppressive medication (cyclosporine, steroid and azathioprine)