treatments, bath additives or soap substitutes. there are many different products but the majority of leave-on treatments (least to most greasy) are lotions, creams, gels or ointments. none of the different types of moisturisers are more effective than the others so people need to choose one or more products that suit them, according to their age, body site effected, climate/season and personal preference. there is no evidence that the additional use of emollient bath additives is beneficial. topical corticosteroids applied directly on skin (topical) have proven effective in managing atopic dermatitis. newer (second generation) corticosteroids, such as fluticasone propionate and mometasone furoate, are more effective and safer than older ones. strong and moderate corticosteroids work better than weaker ones. they are also generally safe when used in intermittent bursts to treat ad flare-ups. applying once daily is as effective as twice or more daily application. if topical corticosteroids and moisturisers fail, short-term treatment with topical calcineurin inhibitors such as tacrolimus or pimecrolimus may be tried. both tacrolimus and pimecrolimus are effective and safe to use in ad. crisaborole, an inhibitor of pde-4, is also effective and safe as a topical treatment for mild-to-moderate ad. systemic oral medications used for ad include systemic immunosuppressants such as ciclosporin, methotrexate, interferon gamma-1b, mycophenolate mofetil, and azathioprine. antidepressants and naltrexone may be used to control pruritus (itchiness). leukotriene inhibitors such as montelukast are of unclear benefit as of 2018. in 2017, the monoclonal antibody(mab) dupilumab under the trade name dupixent was approved to treat moderate-to-severe eczema. in 2021, an additional monoclonal antibody, tralokinumab, was approved in the eu & uk with the trade name adtralza then later in the us as adbry for similarly severe cases. as of 2023, another monoclonal antibody treatment, lebrikizumab, is awaiting approval in the us and europe. some jak inhibitors such as abrocitinib, trade name cibinquo, and upadacitinib, trade name rinvoq, have been approved in the us for the treatment of moderate-to-severe eczema as of january 2022. allergen immunotherapy may be effective in relieving symptoms of ad but it also comes with an increased risk of adverse events. this treatment consists of a series of injections or drops under the tongue of a solution containing the allergen. antibiotics, either by mouth or applied topically, are commonly used to target overgrowth of s. aureus in the skin of people with ad, but there is insufficient evidence for the effectiveness of anti-staphylococcal treatments for treating s. aureus in infected or uninfected eczema. diet the role of vitamin d on atopic dermatitis is not clear, but vitamin d supplementation may improve its symptoms. there is no clear benefit for pregnant mothers taking omega 3 long-chain polyunsaturated fatty acid (lcpufa) in preventing the development of ad in their child. several probiotics seem to have a positive effect, with a roughly 20% reduction in the rate of ad. probiotics containing multiple strains of bacteria seem to work the best. in people with celiac disease or nonceliac gluten sensitivity, a gluten-free diet improves their symptoms and prevents the occurrence of new outbreaks. use of blood specific ige or skin prick tests to guide dietary exclusions with the aim of improving disease severity or control is controversial. clinicians vary in their use of these tests for this purpose and there are very limited evidence of any benefit. lifestyle health professionals often recommend that people with ad bathe regularly in lukewarm baths, especially in salt water, to moisten their skin. dilute bleach baths may be helpful for people with moderate and severe eczema. avoiding woolen clothing or scratchy fibres is usually recommended for people with ad as they can trigger a flare. self-management treatment regimens can be confusing and written action plans may support people to know what treatments to use where and when. a website supporting self-management has been shown to improve ad symptoms for parents, children, adolescents and young adults. light phototherapic treatment involves exposure to broad- or narrow-band ultraviolet (uv) light. uv radiation exposure has been found to have a localized immunomodulatory effect on affected tissues and may be used to decrease the severity and frequency of flares. among the different types of phototherapies only narrowband (nb) ultraviolet b (uvb) exposure might help with the severity of ad and ease itching. however, uv radiation has also been implicated in various types of skin cancer, and thus uv treatment is not without risk. uv phototherapy is not indicated in young adults and children due to this risk of skin cancer with prolonged use or exposure. alternative medicine while several chinese herbal medicines are intended for treating atopic eczema, no conclusive evidence shows that these treatments, taken by mouth or applied topically, reduce the severity of eczema in children or adults. epidemiology since the beginning of the 20th century, many inflammatory skin disorders have become more common; ad is a classic example of such a disease. it now affects 15–30% of children and 2–10% of adults in developed countries, and in the united states has nearly tripled in the past 30–40 years. over 15 million american adults and children have ad. society and culture conspiracy theories a number of false and conspiratorial claims about ad have emerged on the internet and have been amplified by social media. these conspiracy theories include, among others, claims that ad is caused by 5g, formaldehyde in food, vaccines, and topical steroids. various unproven theories also claim that vegan diets, apple cider vinegar, calendula, and witch hazel can cure ad and that air purifiers reduce the risk of developing ad. research evidence suggests that il-4 is central in the pathogenesis of ad. therefore, a rationale exists for targeting il-4 with il-4 inhibitors. people with atopic dermatitis are more likely to have staphylococcus aureus living on them. the role this plays in pathogenesis is yet to be determined.