Table 3.

Other potential treatment options for patients with moderate-to-severe atopic dermatitis (AD) in Asia: Insights from physicians practicing in nine Asian countries and territories

Treatment options	Considerations
Antihistamines	• Antihistamines are not recommended for the treatment of AD [13, 16, 22, 120]a Nonetheless, sedating histamines may be suggested in patients with sleep disturbance due to itch [13–15, 17]b • Physicians should be mindful of the sedating side effects of any antihistamines and consider patients’ professionc when prescribing antihistamines
Antibiotics	• Appropriate antibiotics (e.g., cloxacillin, cephalexin, and erythromycin) may be required when secondary infection occurs [13–17, 22] • The use of prophylactic antibiotic treatment in patients with AD is not recommended [13–17] • Bleach bath (sodium hypochlorite 0.005%) may be useful in patients with recurrent infections as it has anti-inflammatory effects and can help kill bacteria on the skin [13, 15, 22]
Allergen-specific immunotherapy (ASIT)	• The use of ASIT is not recommended due to limited scientific evidence regarding its effectiveness [13, 22, 121]d
Traditional complementary and alternative medicine (TCAM)	• Although TCAM (e.g., Chinese herbal medicine and acupuncture) is often used by Asians, more clinical trial data are needed to establish its safety and efficacy [15, 22, 122, 123]
Vitamin D supplements	• While some data have suggested a potential link between vitamin D deficiency and an increased risk of developing AD, there is a lack of sufficient double-blind, placebo-controlled trials to conclusively demonstrate the efficacy of vitamin D supplementation in improving AD symptoms [13, 15, 16, 124, 125]
Avoidance of specific foods	• Food avoidance is not advocated unless there are concomitant urticaria, angioedema or gastrointestinal symptoms associated with specific foods [13, 14, 22]e • If there is any proof of allergies, identified food allergens should be avoided to prevent the aggravation of patients’ AD [22]f

AD atopic dermatitis, ASIT allergen-specific immunotherapy, JAK Janus kinase, TCAM traditional complementary and alternative medicine

^aAlthough often prescribed in daily practice, antihistamines are not effective in treating AD due to the complex pathophysiology of AD [13, 16, 22, 120]

^bBased on the 2023 Indonesia Guideline of Systemic Treatment for Adults with Atopic Dermatitis, antihistamine-1 (sedative/non-sedative) and antihistamine-2 (cimetidine) are still part of the AD treatment in Indonesia

^cSuch as those who work as drivers, operate heavy machineries, or children who need to attend exams or schools

^dA recommendation for ASIT in the 2020 Thailand clinical practice guidelines was limited to patients with respiratory symptoms rather than for all patients with AD [16]

^eThis is pertaining to low evidence, impracticality, and the potential result of malnutrition [126–128]

^fIf flares do occur despite the avoidance of potential food allergens, one possible explanation would be that the flareup could be due to airborne allergens, which are difficult to avoid completely