How is eczema (atopic dermatitis) treated?

What specialists treat atopic dermatitis?

Allergists, dermatologists and paediatricians (when the affected person is a child) will typically care for and treat those suffering from atopic dermatitis. Some general practitioners are also comfortable with diagnosing and treating the condition.

Treatment for atopic dermatitis

The treatment options for atopic dermatitis aid in easing the symptoms of the conditions while also trying to control them. Unfortunately, there is no cure for the condition at present, yet a number of children will have their symptoms improve naturally as they grow out of childhood.

Atopic dermatitis is often a persistent condition, because of this, several different treatment options may be necessary over a number of years in an attempt to control the bothersome symptoms. Should the treatment be effective, the success is sometimes short-lived as the symptoms may re-occur.

It is vital that the condition be recognised early so as to begin treatment as soon as possible. If the generally prescribed self-care tips of regular moisturising and other steps (these typically include applying bandages to cover the affected area, taking a warm bath, using a humidifier, applying anti-itch creams or taking anti-itch medication) are not successful, then the doctor may suggest some of the below treatment options:

The main treatments used to treat atopic eczema include:

• Moisturisers known as emollients which will be applied daily to prevent the skin from drying.
• Ointments and creams known as topical corticosteroids which aid in reducing redness and swelling during flare-ups.

Some other forms of treatment include:

• Topical treatments referred to as tacrolimus or pimecrolimus are used for eczema that develops in sensitive areas and does not respond to other simpler forms of treatment.
• Antihistamines are commonly used to relieve itching.
  • **My Med Memo – Antihistamines tame the symptoms of allergies by combatting the effects of histamines. Histamines are chemicals produced by the body as an immune system reaction to an allergen. Histamines boost the blood flow to the affected area, resulting in inflammation.
• Specialised body suits or bandages are used to allow for the body to heal and to prevent exposure to environmental factors such as heat and other allergens.

Medications for atopic dermatitis

• Creams for controlling itching and repairing the skin – A doctor may prescribe a corticosteroid ointment or cream. This cream will be applied as directed and after having applied moisturiser (emollient). Thinning skin is a common side effect of overusing these drugs.
  
  There are also other creams available known as calcineurin inhibitors, some of these include pimecrolimus (Elidel) and tacrolimus (Protopic), which influence the immune system, causing it to halt production of the substances that cause eczema. These creams are designed for those who are older than two years of age. It is advised that individuals avoid direct sunlight when using these medications as the skin may be compromised in its ability to protect itself from sun damage. The heat from the sun may also aggravate any skin irritations and rashes.
  
  The above-mentioned drugs do have a warning regarding their potential cancer-causing risk, however, these medications are being further investigated and a number of experts still recommend them in the treatment of eczema, noting that cancer as a side effect is unlikely.
• Medications to fight off infections – A doctor may prescribe an antibiotic cream should the skin have a bacterial infection, significant cracks or open sores. Oral or topical antibiotics may be taken for a short period of time to combat the infection, prevent it from spreading and heal any wounds present. Penicillin derivatives such as dicloxacillin or flucloxacillin are usually prescribed, or erythromycin for those who are allergic to penicillin.
• Drugs to control inflammation (immunosuppressants) – For people suffering from severe atopic dermatitis, a doctor may prescribe prednisone. This is an oral corticosteroid that is effective in treating the symptoms short-term, however, there are some serious side effects that are associated with taking these drugs long-term such as slow wound healing, headaches and sleep issues. Immunosuppressants work by controlling the immune response by suppressing the immune system. Other forms of these drugs include ciclosporin, methotrexate and azathioprine.
• Newly developed options for treating severe eczema – The FDA (Food and Drug Administration) recently approved an injectable biologic, also known as a monoclonal antibody. Injectable biologics are antibodies designed to block the inflammatory response of the immune system to certain allergens. This new drug is known as dupilumab (Dupixent) and is used for those who suffer from severe eczema and have not responded to other forms of treatment. Because this drug is new, it is expensive and the evidence of success in studies conducted is limited. However, a number of experts regard the medication to be extremely effective.

Therapies for atopic dermatitis

• Wet dressings – This intensive, yet effective treatment is for those who suffer from more severe cases of atopic dermatitis. Wet dressings involve wrapping the affected areas with wet bandages and topical corticosteroids. This can sometimes be done in a hospital setting for those who have widespread lesions as the process can be labour-intensive, therefore nursing staff and expertise can be beneficial. Doctors can also advise their patients on how to do this at home.
• Light therapy – This form of treatment is helpful for those who either do not respond to topical treatments or who usually flare up after being treated. A simple form of phototherapy (also known as light therapy) involves the skin being exposed to controlled amounts of natural sunlight. Experts believe that the natural vitamin D that comes from sunlight may be beneficial in healing eczema. The other forms of light therapy include UVA (artificial ultraviolet A) and UVB (narrowband ultraviolet B) exposure. These forms of light therapy are able to reduce inflammation and are often used in combination with other medications.
  
  Light therapy may also have some adverse side effects that include an increased risk of skin cancer and premature ageing of the skin. As a result, doctors suggest that older patients opt for light therapy and do not recommend this form of treatment for infants and children as their skin may be too sensitive to UV rays.  

• Counselling – Eczema can be an extremely frustrating condition to deal with due to the constant itching it causes. Atopic dermatitis can also be an embarrassing ailment as it can impact one’s aesthetic appearance. Some people may benefit from speaking to a therapist or counsellor in order to discuss their frustrations and develop effective coping techniques in dealing with the disorder.
• Biofeedback – Some patients have found biofeedback to be particularly helpful in using this technique to control their involuntary function of wanting to scratch their rashes. Biofeedback involves gaining a greater understanding of the functions of the body that seem to be out of our control. This form of treatment will connect the sufferer to electrical sensors that help him or her to receive information (feedback) about their body (bio). This feedback will help the person to focus on how to make subtle changes in their body, such as relaxing specific muscles, in order for them to achieve the desired result. The theory behind this practice is that it gives a person the power to control their thoughts in order to control their body. Biofeedback can prevent eczema from progressing and promote healing as the individual will learn not scratch the affected areas as scratching can aggravate atopic dermatitis and lead to open wounds, sores and infection. No drugs are involved in this form of treatment.

Lifestyle and home remedies for atopic dermatitis

The below section outlines some self-care techniques that can be beneficial in soothing itching or inflamed skin:

• Moisturise skin twice daily – It is advised that an individual suffering from atopic dermatitis find a product or product combination that works best for them. Creams, ointments and bath oils are helpful emollients. Emollients aid in reducing water loss from the skin and provide a protective covering. Moisturising the skin can have a mild effect on reducing inflammation and prevent further aggravation that is often the result of dry skin. Children should be moisturised after bathing at night and again in the morning.
• Apply anti-itch creams to the affected areas – There are some over-the-counter creams available that may be able to offer temporary relief to itching. These creams are known as hydrocortisone creams and will need to contain no less than one percent of hydrocortisone. It is advised that the individual apply these creams to the affected areas after moisturising as this may help the treatment to better penetrate the skin. Hydrocortisone creams should not be used more than twice daily. If milder creams do not work, then the doctor may prescribe moderate strength creams such as clobetasone butyrate, or even stronger options which may include mometasone. Bear in mind that stronger options will need a prescription.
• Take anti-itch or anti-allergy medication orally – Some non-prescription options for anti-allergy medications include fexofenadine (Allegra) or cetirizine (Zyrtec), these are known as antihistamines. Severe itching can be relieved through oral medications such as diphenhydramine (Benadryl). Benadryl is often better when taken at night time as it can result in drowsiness.
• Avoid scratching – It is advised that people with atopic dermatitis refrain from scratching when they experience itching. It may also help to trim children’s nails or make them wear cotton gloves when sleeping to stop involuntary scratching. Short nails will result in far less damage to the itchy skin.
• Take lukewarm baths – Lukewarm water temperatures are advisable when bathing to prevent further skin aggravation caused by extremely hot baths or showers. Baking soda or uncooked oatmeal sprinkled into baths can sometimes aid in relieving inflammation. Soak for about 15 minutes and then pat the skin dry, be careful not to rub vigorously with a towel. Once dry, apply moisturiser while the skin is still damp as this promotes absorption.
• Use mild soaps, perfumes or dyes – An eczema sufferer will be advised to opt for products that do not aggravate the skin, unscented creams are sometimes best as the alcohol and perfumes in fragranced moisturisers can irritate the skin.
• Install a humidifier – For dry, hot indoor spaces which often result in dry skin and exacerbate eczema, worsening flaking and itching, using a humidifier is extremely beneficial in adding moisture to the air.
• Wear smooth-textured and cool clothing – Irritation can be reduced by wearing clothes that are loose fitting and appropriate to the weather or exercise activity one is engaging in as opposed to tight, scratchy or rough clothes.
• Treat anxiety and stress – Emotional disorders such as stress have been identified as triggers for eczema. It is advised that people suffering from emotional conditions learn how to recognise these and seek the necessary treatment (if need be). Parents of children with eczema should try to keep them in calm and relaxing situations and teach them appropriate coping mechanisms in order to minimise anxiety and emotional stress as far as possible.

How do I stop my child from scratching their eczema?

The above information describes a number of ways in which one can stop itching and soothe the symptoms of atopic dermatitis. The below section mentions some easy and effective methods parents of children with atopic dermatitis and doctors recommend:

Wet wraps

Secondary to applying moisturiser in the morning and after bath time in the evening, wet wraps are a popular method to stop children from itching and scratching their eczema. The best time to use a wet wrap is before bedtime. The information below describes how to use these:

1. Have the child soak in a lukewarm bath for roughly ten minutes.
2. After bathing, gently pat (ensuring not to rub and further irritate the skin) with a soft towel and apply
3. Slightly moisten clean bandages with water and then wrap the affected skin.
4. Cover these wet bandages with a dry bandage or towel in order for the moisture to be locked in, this can be left overnight.

Use a cold compress

Applying a cold, damp washcloth (facecloth) to the itchy area can soothe the skin. It may also be beneficial to use an ice pack covered with a damp cloth. Hold this cold compress to the skin for a couple of minutes to relieve itching as often as is necessary.

Coping and support for atopic dermatitis sufferers

Regardless of the bothersome symptoms that are a result of atopic dermatitis, most sufferers are still able to live a healthy and fulfilling life, without their quality of life depleting to any noticeable extent.

The keys to maintaining a good quality of life are awareness, education and creating a partnership between the doctor, sufferer and their family (the latter if the patient is a child). It is essential that an affected person make communication a priority when discussing issues regarding their condition with their doctor.

It is also important that the treating doctor is able to provide understandable forms of information about the disorder, its symptoms and what to expect. Parents of children with the condition will need to be informed about treatment and educated about eczema to better enable them to deal with their child’s condition at home.

Parents of infants and children with severe atopic dermatitis may have their lives affected to a degree as the child may become difficult and fussy due to the discomfort caused by this form of eczema. Keeping children from scratching is a common issue faced by families dealing with the condition. Giving an affected child as many tasks and activities as possible to keep them busy and distracted often requires a large amount of effort and work from parents, but this effort is well worth it. 

What is the prognosis for atopic dermatitis?

Atopic dermatitis is a condition that can be easily managed when the right techniques are utilised and treatment in more severe cases is effective and carried out correctly in order to ensure success. Although the condition can be one that is irritating in terms of the constant itchiness and urge to scratch, those with atopic eczema are able to lead productive and healthy lives.

In some cases, atopic dermatitis may develop a secondary infection with microorganisms such as the herpes simplex virus or staphylococci. These infections occur when the protective barrier of the skin is damaged due to inflammation and the resultant scratching. In situations such as these, an infection may become contagious and require treatment in the form of antibiotics. Pain, fever, pustules (bumps with yellow heads, almost resembling those of pimples forming on the rash) are common signs of infection and warrant medical attention.