What is the treatment for atopic dermatitis?
If the disease does not respond to mild local over-the-counter treatment then a physician is required. With proper treatment, most symptoms can be brought under control within three weeks.
Topical corticosteroid creams and ointments are the most frequently used treatment. Since many of these are quite potent it will be necessary to have frequent physician visits to assure that the treatment is successful.
Tacrolimus (Protopic) and pimecrolimus (Elidel) are non-steroid topical ointments that contain molecules that inhibit a substance called calcineurin which is important in inflammation. They rather expensive topical medicated creams that are used for the treatment of atopic dermatitis. They are particularly effective in when used on the faces of children since they seem less likely to produce atrophy. These new drugs are referred to as “immune modulators.”
Crisaborole (Eucrisa), a recently approved topical treatment for children and adults with mild to moderate atopic dermatitis (AD) which seems to work by inhibiting a different portion of the inflammatory cascade in skin.
Dupilumab (Duxipent) was recently approved by the FDA for treatment of moderate to severe atopic dermatitis in adults. It is an anti-IL-4 antibody that is given by injection twice a month and shows great promise in the control of severe atopic dermatitis.
A newer class of OTC (over the counter) creams have been recently developed which claim to repair and improve the skin’s barrier function in both children and adults. They include Atopiclair, MimyX, and CeraVe. These creams may be used in combination with topical steroids and other emollients to help repair the overall dryness and broken skin function.
Additional available treatments may help to reduce specific symptoms of the disease. Oral antibiotics to treat staphylococcal skin infections can be helpful in the face of pyoderma. Certain antihistamines that cause drowsiness can reduce nighttime scratching and allow more restful sleep when taken at bedtime. This effect can be particularly helpful for patients whose nighttime scratching aggravates the disease. If viral or fungal infections are present, the doctor may also prescribe medications to treat those infections.
Phototherapy is treatment with light that uses ultraviolet A or B light waves or a combination of both. This treatment can be an effective treatment for mild to moderate dermatitis in older children (over 12 years old) and adults. Photochemotherapy, a combination of ultraviolet light therapy and a drug called psoralen, can also be used in cases that are resistant to phototherapy alone. Possible long-term side effects of this treatment include premature skin aging and skin cancer. If the doctor thinks that phototherapy may be useful in treating the symptoms of atopic dermatitis, he or she will use the minimum exposure necessary and monitor the skin carefully.
When other treatments are not effective, the doctor may prescribe systemic corticosteroids, drugs that are taken by mouth or injected into muscle instead of being applied directly to the skin. An example of a commonly prescribed corticosteroid is prednisone. Typically, these medications are used only in resistant cases and are only given for short periods of time. The side effects of systemic corticosteroids can include skin damage, thinned or weakened bones, high blood pressure, high blood sugar, infections, and cataracts. It can be dangerous to suddenly stop taking corticosteroids, so it is very important that the doctor and patient work together in changing the corticosteroid dose.
In adults, immunosuppressive drugs, such as cyclosporine, are also used to treat severe cases of atopic dermatitis that have failed to respond to any other forms of therapy. Immunosuppressive drugs restrain the overactive immune system by blocking the production of some immune cells and curbing the action of others. The side effects of cyclosporine can include high blood pressure, nausea, vomiting, kidney problems, headaches, tingling or numbness, and a possible increased risk of cancer and infections. There is also a risk of relapse after the drug is discontinued. Because of their toxic side effects, systemic corticosteroids and immunosuppressive drugs are used only in severe cases and then for as short a period of time as possible. Patients requiring systemic corticosteroids or immunosuppressive drugs should be referred to a dermatologist or an allergist specializing in the care of atopic dermatitis to help identify trigger factors and alternative therapies.
In extremely rare cases, when no other treatments have been successful, the patient may have to be hospitalized. A five- to seven-day hospital stay allows intensive skin care treatment and reduces the patient’s exposure to irritants, allergens, and the stresses of day-to-day life. Under these conditions, the symptoms usually clear quickly if environmental factors play a role or if the patient is not able to carry out an adequate skin care program at home.
Atopic dermatitis and quality of life
Despite the symptoms caused by atopic dermatitis, it is possible for people with the disorder to maintain a high quality of life. The keys to an improved quality of life are education, awareness, and developing a partnership among the patient, family, and doctor. Good communication is essential for all involved. It is important that the doctor provides understandable information about the disease and its symptoms to the patient and family and demonstrate any treatment measures recommended to ensure that they will be properly carried out.
When a child has atopic dermatitis, the entire family situation may be affected. It is important that families have additional support to help them cope with the stress and frustration associated with the disease. The child may be fussy and difficult and often is unable to keep from scratching and rubbing the skin. Distracting the child and providing as many activities that keep the hands busy are key but require effort and work on the part of the parents or caregivers. Another issue a family may face is the social and emotional stress associated with disfigurement caused by atopic dermatitis. The child may face difficulty in school or other social relationships and may need additional support and encouragement from family members.