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Atopic Dermatitis Treatment overview While there is no "cure" for eczema, several types of treatments relieve the rash and the itching. This section has information on:
"Soak and seal" skin care The best way to put moisture back into dry, itchy skin is to follow a regimen called "soak and seal." It involves four steps:
Tar-based soaps and shampoos Skin and scalp products that contain coal-tar extracts have long been used to reduce itching and rash. They are not as strong as some other medicines, but they have long-lasting action against inflammation and have few side effects. Tar-based shampoos are helpful if the scalp is red and itchy. One popular brand is T-Gel. Topical steroids Steroid medications applied directly to the skin are called topical steroids. They fight inflammation, and so reduce itching and help keep the rash under control. Topical steroid come in many forms including ointments, creams, lotions, and gels. Because they come in different strengths you should not substitute one for another without consulting with your healthcare provider. They are generally safe drugs when used properly, although they can have side effects. For instance, they may cause thinning of skin, particularly on the face, which can make the blood vessels underneath appear more prominent. Topical steroids also can cause acne. A commonly prescribed medium-strength topical steroid for atopic dermatitis is triamcinolone cream or ointment. A commonly used over-the-counter steroid cream or ointment is hydrocortisone. Systemic steroid pills or liquids, like prednisone, generally aren't used to treat atopic dermatitis because of their side effects and because the rash often comes back after they are stopped. Topical immunomodulators/topical calcineurin inhibitors Like topical steroids, these new drugs are applied directly to the skin as ointments or creams, and they work to reduce immune-system overactivity, thus diminishing the rash and itching. But unlike steroids, which have general anti-inflammatory effects on many kinds of cells, the new medicines are targeted more specifically at skin cells. These medicines can be particularly useful for patients who do not respond to conventional therapy. They also are used to treat rashes on the face and neck, where the thinning of the skin occasionally caused by steroids can be a particular problem. The most commonly seen side effect is a burning sensation on the skin, but this usually does not last long. Currently, approved topical immunomodulators include Protopic (tacrolimus) ointment and Elidel (pimecrolimus) cream. Antihistamines Some oral antihistamines that cause drowsiness, such as Atarax (hydroxyzine) and Benadryl (diphenhydramine), can be helpful at night. In addition to reducing itching, these medications can help patients fall asleep. Oral antihistamines that aren't sedating, such as Claritin (loratadine), generally aren't as useful. Topical antihistamine creams, or creams that contain anesthetics, should be avoided. They can further irritate the skin. Fighting skin infections Infections with bacteria and viruses are common among atopic dermatitis patients. For instance, over 90 percent of patients have the bacteria Staphylococcus aureus on their skin, and the breaks in the skin barrier caused by the rash and by scratching can lead to infection. It's very important that such infections be treated properly and promptly. For small, localized bacterial infections, a prescription topical antibiotic called mupirocin is often used. This is an ointment usually applied to the affected area 3 times per day for 1 to 2 weeks. The brand name of this drug is Bactroban. For larger bacterial infections, a prescription systemic antibiotic called a cephalosporin is used. This is a pill, capsule, or liquid, and the exact dosage will be determined by a healthcare provider based on the bacteria to be treated and a patient's age, weight, and other physical conditions. Viral infection is another complication of atopic dermatitis. Herpes simplex is a common viral culprit. Anti-infective drugs usually prescribed along with anti-inflammatory medication such as topical steroids or topical immunomodulators. These reduce the area of skin irritation, giving the infectious organisms fewer places to colonize and grow. Good skin hydration is also important in restoring the skin barrier to infectious agents. Wet wraps When symptoms are severe, your healthcare provider may suggest wet wraps. These are dressings--often made from articles of clothing--that have been soaked in water. Apply wet wraps to skin after soaking and sealing, and after applying any topical medicine. The wraps help keep skin moist and increase absorption of medicine. They also have a cooling effect. Re-wet or take the wraps off when they start to dry out. Phototherapy Exposure to natural sunlight or ultraviolet light often helps people with atopic dermatitis. However, it can be counterproductive if at the same time patients are exposed to heat and humidity, which causes them to perspire and itch or get sunburned. Phototherapy with many different types of ultraviolet light may be prescribed, such as broad-band ultraviolet B (UVB), broad-band ultraviolet A (UVA), narrow-band UVB, or combined UVAB light. This treatment should be used in conjunction with other therapies. It also should be reserved for patients with especially severe atopic dermatitis because of potential long-term adverse effects, including premature aging of the skin and skin cancer. Psychological counseling People with AD often struggle with a poor self-image and low self-esteem. In severe cases, the appearance of their skin can invite teasing and, especially with children, interfere with peer relationships. The sleep disturbances that may accompany AD put added stress on individuals and those closest to them. AD patients who are experiencing a lot of stress may benefit from psychological counseling or even from taking antianxiety drugs. Relaxation therapy and biofeedback also can be helpful for people who are finding it hard to control their scratching. Day hospitalization Day hospitalization at centers specializing in treatment of skin disorders can be helpful for patients whose rashes are not controlled by medications and avoiding irritants. Patients spend their days in a hospital and go home at night. This can help get treatment back on track several ways: First, it removes the patient from allergens in the home. It also allows the patient to be seen concurrently by a team of specialists: allergist-immunologists, nurse-educators, and nutritionists. Team members assist in a patient's self-care regimen so they can teach the patient proper techniques. Antibiotics may be administered to fight secondary skin infections, if present. This hospital time also may be used for testing for specific triggers of atopic dermatitis, under controlled conditions. Most people's AD improves significantly during hospitalization so they are able to avoid more aggressive treatments. Day hospitalization programs usually last 1 to 2 weeks. |
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