Atopic dermatitis (Eczema) is one of the most frustrating and most difficult diseases to control. Parents feel depressed, children feel miserable, and patients will try anything for relief. There is no cure for atopic dermatitis, but there are ways to keep the skin under control.
Finding Relief for Eczema
Many preparations exist to help reduce the inflammation, dryness, and itching. You can use moisturizing creams and ointments, topical steroid preparations, antibacterial ointments for secondary skin infections, and a new class of creams and ointments now available which actually help reduce or suppress the immune cascade response and inflammation seen in the skin.
An allergist is an expert in the diagnosis, treatment and management of atopic dermatitis. All patients with atopic dermatitis should be seen at some point by an allergist. Environmental allergens and food allergies can contribute to atopic dermatitis. Skin testing or a blood test called RAST for IgE will help the allergist determine what may be contributing to the eczema. Food allergies are often life threatening. Some foods stimulate an allergic response affecting the skin with eczema and the nose with nasal congestion and nasal drainage.
Atopic dermatitis can be very frustrating for the patient and parents. Patients need to be aggressive and try to reduce the amount of work and medications involved in treating the eczema. This will assure better control of the eczema and an improved attitude for all.
Below are tips for managing Atopic Dermatitis.
The best treatment is moisture. By keeping the skin moist, there will be a reduction in the itching and dryness. Unfortunately, this is not easy.
All kinds of creams and ointments can be used. Aquaphor ®, Eucerin ®, Vanacream ®, or Vaseline ® need to be placed daily on the areas that are dry and itchy. Atopic dermatitis seems to reappear in the same places.
Keeping the skin moist with creams or ointments is important. Many products are available that lubricate and moisturize, but there is no perfect one for each individual, so experiment with moisturizers that are comfortable, easy to apply and not expensive.
When children begin to scratch, give them something to do by applying a moisturizer on the skin, rather than scratching.
Creams & Ointments
Steroid based creams and ointments can be used, and depending on the potency (how strong the cream is) they may be prescribed for once or several times per day during flare-ups. A mild steroid preparation can be premixed by the pharmacist and these preparations can be placed on areas wherever flare-ups are happening.
Your doctor will advise you on how often steroids can be used. Stronger steroid preparations can be used, but they can cause thinning of the skin. Stronger steroid preparations should not be used daily. They can be used a few days on and a few days off, your physician will tell you how often it can be applied. Many times parents and patients get tired of using daily creams and ointments, so using a stronger steroid cream when needed on the areas that are flaring up will control a flare-up and keep the rest of the skin calm.
Other new options are Pimecrolimus, called Elidel® 1% and Tacrolimus, called Protopic® 0.03% and 0.1%. These preparations are considered topical calcineurin inhibitors. These preparations can be used for extended periods of time and actually reduce the cascade of inflammation that will irritate the skin. Contact your physician for a prescription for these medications. At times, these preparations will be provide control when used alone, or during other times they can be used with other steroid preparations and always in conjunction with moisturizing creams. One approach can be to use Elidel® or Protopic® often, moisturize daily and use the steroid preparations for flare ups.
Adding oral antihistamines can be helpful and are frequently recommended. A major mediator is histamine.
You have felt histamine before; remember the last time you were bitten by a mosquito. The mosquito injects the histamine into the skin and it gets itchy, red and inflammed. The more you scratch, the more chemical mediators are released. This stimulates more itching and makes the atopic dermatitis worse.
An oral antihistamine may also help reduce allergic rhinitis, nasal congestion, and nasal drainage.
Antibiotics are used to address secondary skin infections that can appear often. Since the surface of the skin is scratched, the bacteria on the surface can get under the skin and cause an infection. Infections lead to flare-ups all over the skin. The bacterium is typically Staphylococcus aureus.
The individual can be affected by the bacteria or may even react to the bacteria in a superantigen context. The individual with atopic dermatitis is not able to eradicate the Staphylococcus aureus and the bacteria interact on the skin, in conjunction with the individual’s immune system, causing an increase in inflammation on the surface of the skin.
Fungal infections can also occur, as a form of skin infection. At times, topical antibacterial ointments like Neosporin® or Bactroban®, or even oral antibiotics may be very helpful. A topical and/or oral anti-fungal medication may be needed at times.
Allergy shots, also called immunotherapy, may be helpful for some patients with atopic dermatitis. Some studies show a benefit, while others do not.
If the patient is significantly affected by their allergies and suffers from atopic dermatitis, immunotherapy may be a good idea.
By controlling the allergic patient more effectively, the atopic dermatitis may also improve.
Other Tips for Managing Atopic Dermatitis (Eczema)
- Reduce the use of soap when bathing. Soap will wash away the body’s natural moisture. Use soap and shampoo on certain areas, toward the end of your bathing.
- Dry yourself by blotting water off with a towel… rubbing will irritate the skin and cause itching. Sitting in the water or shower is fine, but try not to use extremely hot water, since this will also wash off the skin’s natural oils.
- After bathing, place moisturizing cream or lotion liberally all over your body, especially in the dry areas.
- Moisturize the skin
- Treat irritated skin flare ups (hot spots) aggressively to gain early control
- Various topical preparations can be used, such as moisturizers, topical steroids, calcineurin inhibitors, and topical antibiotics
- At times, oral steroids or oral antibiotics may be needed
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