Treatment consideration will depend on specific clinical signs.15
Phase I: To aim for induction of remission, consider rapid-acting and broad-targeting drugs:
Severe cutaneous inflammation: Oral +/– topical glucocorticoids. Topical glucocorticoids are ideal to treat localized inflamed or lichenified skin lesions.
Mild cutaneous inflammation: oclacitinib or ilunocitinib.24
Consider transition from glucocorticoids to oclacitinib or ilunocitinib once cutaneous inflammation subsides from severe to mild inflammation.
Consider combining oclacitinib or ilunocitinib with topical glucocorticoid if lesions are mild.
Phase II: The aim is to prevent reccurence of flare-up.
Topical Medications:
Proactive topical glucocorticoid treatment of previously affected areas twice weekly can help prevent allergic flares
Proactive use of antiseptic (e.g. chlorhexidine) shampoos, mousses, and wipes can help prevent yeast and bacterial overgrowths
Oral Medications:
In patients with allergies with severe inflammation and skin thickening:
Consider cyclosporine or short courses of oral glucocorticoids
In patients with allergies with minimal inflammation and skin thickening:
Consider lokivetmab, oclacitinib, or ilunocitinib
Immunotherapy is the only treatment to retrain the immune system and reduce the amount of medication needed long term
Allergy avoidance can be attempted
Treatment strategies can be reassessed periodically
