Atopic Dermatitis: Treatment in Children and Adults

Atopic dermatitis (AD) is a chronic skin condition that affects close to 18 million people. It’s characterized by dry skin and a persistent itch. AD is a common type of eczema.
There is currently no cure for atopic dermatitis, but treatment can prevent symptoms from worsening, relieve the pain and itch, prevent infections from developing, and stop the skin from thickening, also called lichenification. Therefore, finding a good prevention and treatment plan for AD is essential. Untreated AD will continue to itch and lead to more scratching. Once you start scratching, you’re at greater risk of infection.
Effective treatment can help you maintain a higher quality of life and get better sleep. Both are essential for reducing stress, which can lead to increased flare-ups.
There are different treatment options for AD, these include medications, therapies, lifestyle and home remedies.

Medications

  • Creams that control itching and help repair the skin.

    Keeping your skin hydrated is one of your best defenses against unpleasant symptoms. Moisturization not only soothes the dry, itchy skin associated with eczema, but it also helps to repair the skin barrier function. This is important because during a flare-up, particularly when you scratch uncontrollably, tears in the skin barrier make you more prone to bacterial, viral, and fungal infections, according to the National Eczema Society.

    Prescribed corticosteroid cream or ointment will help decrease inflammation. Other creams containing drugs called calcineurin inhibitors — such as tacrolimus (Protopic) and pimecrolimus (Elidel) — affect your immune system. They are used by people older than age 2 to help control the skin reaction. Apply it as directed, after you moisturize. Avoid strong sunlight when using these products.

  • Drugs to fight infection.

    Antibiotic cream may be prescribed if your skin has a bacterial infection, an open sore or cracks. Your physician may recommend taking oral antibiotics for a short time to treat an infection.

  • Oral drugs that control inflammation.

    For more-severe cases, your doctor may prescribe oral corticosteroids such as prednisone. These drugs are effective but can’t be used long term because of potential serious side effects.

  • Newer option for severe eczema.

    Food and Drug Administration (FDA) has recently approved the first biologic medication called dupilumab (Dupixent). It is used to treat people with severe disease who do not respond well to other treatment options. In clinical trials, Dupixent was shown to reduce symptoms of AD such as itching, redness, lichenification (thickened skin), swelling, and scratched skin. Dupixent is available by prescription only.

Therapies

  • Wet dressings

    During particularly intense eczema flares with severe itch or pain, wet wrap therapy can work wonders to rehydrate and calm the skin and help topical medications work better. The fabric wraps are soaked in water and applied to the affected skin on the body. Face wraps use gauze and surgical netting, and are made and applied by nurses trained in this treatment. Consult with a health care provider prior to starting wet wrap therapy.

  • Identification of triggering allergens

    Atopic dermatitis is a type of eczema that is triggered by allergy to environmental allergens, such as pet dander, dust mites and pollens. Skin testing helps identify the sensitivity. Avoiding specific triggers helps prevent new flairs.

  • Phototherapy

    This is also called light therapy, that involves treatment with a special kind of light. It is prescribed to treat atopic dermatitis, contact dermatitis, dyshidrotic eczema, nummular eczema and seborrheic dermatitis. This uses a special machine to emit UVB light, which is the best part of natural sunlight for treating eczema.
    About 70% of people with eczema get better with phototherapy. Some people find that phototherapy puts their eczema in a “remittive” or “quiet” state long past the end of the treatment.

  • Counseling

    Talking with a therapist or other counselor may help people who are embarrassed or frustrated by their skin condition.

  • Relaxation, behavior modification and biofeedback

    These approaches may help people who scratch habitually.

Lifestyle and home remedies

To help reduce itching and soothe inflamed skin, try these self-care measures:

  • Natural moisturizers

    Some natural products can help lock in moisture and relieve itchiness. According to the National Eczema Association, common home remedies that evidence has shown to be effective in adults include coconut oil, sunflower oil and cardiospermum. Prior to using a food based hydration product, check with your allergist.

  • Bathing

    This is essential for eczema as it helps keep the skin hydrated and prevents infection. Always use moisturizer on affected areas of skin within 3 minutes of getting out of the bath to stop the skin from drying out.

  • Keep your fingernails trimmed

    It’s hard to scratch effectively, and therefore hard to cause further damage to your sensitive skin, if your fingernails are short

  • Don’t scratch

    Rather than scratching when you itch, try pressing on the skin. Cover the itchy area if you can’t keep from scratching it. For children, it might help to trim their nails and have them wear gloves at night.

  • Apply bandages

    Covering the affected area with bandages helps protect the skin and prevent scratching.

  • Relaxation techniques

    Stress is a common eczema trigger. Although it’s unclear exactly why, it’s believed that stress plays a role in developing inflammation. Learning to cope with stressful situations using relaxation techniques may help reduce eczema flare-ups.

  • Check out your diet

    Some physicians believe food allergies may play a role in atopic dermatitis, especially in childhood, while others say it hasn’t been proven. If you suspect a particular food aggravates your rash, omit it from your diet for a few weeks. If the rash clears up but then returns when you reintroduce the food in your diet, consider permanently avoiding the food. However, do not eliminate a large number of foods or an entire food group, without consulting your doctor first.

Infant eczema

Treatment for eczema in babies (infantile eczema) includes:

  • Identifying and avoiding skin irritants
  • Avoiding extreme temperatures
  • Lubricating your baby’s skin with bath oils, creams or ointments

See your baby’s doctor if these measures don’t improve the rash or if the rash looks infected. Your baby may need a prescription medication to control the rash or to treat an infection.

Takeaway

With all of these treatment options, you should be optimistic that you will find a way to manage your symptoms. Request an appointment with Dr. Amy Schiffman about creating the best AD treatment plan for you. Contact her at 561-409-2800.

Please call the office to discuss your allergy evaluation needs, and medications to avoid in preparation for testing.

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