An 8 year old child with recalcitrant atopic dermatitis

An 8-year-old child presents to the office with her mother for evaluation of recalcitrant atopic dermatitis. She has had eczema since the age of 3, currently has a diagnosis of mild intermittent asthma, and seasonal allergies to pollen and ragweed. She has been managed by her primary care doctor with mild topical steroids (1 and 2.5 % hydrocortisone) as needed, but this is no longer sufficient to control her symptoms. She is primarily bothered by itching, which is worse at night and not very responsive to oral diphenhydramine. She also feels that her skin is more red and flaky than before.