Atopic dermatitis (AD) is a form of eczema (and also called atopic eczema) that is chronic and relapsing. It primarily affects children, although some people continue to have relapses into adulthood, and it can begin in adulthood, though that is rare.1
When AD relapses and the symptoms are intense, it is referred to as acute AD. The major symptoms of AD are itchiness, redness, and skin irritation, although AD can appear differently in the different stages or phases of the disease.
Phases or stages of atopic dermatitis
- Acute atopic dermatitis: The acute phase appears with vesicles or blisters, weepy skin, and crusting.
- Subacute atopic dermatitis: The subacute phase appears with dry, scaly, red papules and plaques.
- Chronic atopic dermatitis: The chronic phase appears with lichenification, areas of thickened skin from repeated scratching.2
Treatment of acute AD aims to repair and maintain a healthy skin barrier, reduce the inflammation, control the itching, and reduce the chance of infection. In addition to medications that may be over-the-counter or prescribed, a main component of treatment is good skin care.1
Bathing and moisturizing
Bathing is an important step in skin care, as it hydrates the skin and removes scale, crust, irritants, and allergens. Bath water should be warm, not hot, as hot water can trigger AD, worsen itchiness, and dry out the skin. It is generally recommended that bathing, or showering, is done once daily. Bathing may be slightly better than showering to soak inflamed skin.
Immediately following bathing, moisturizers should be applied to the damp skin to seal in moisture and help repair the skin barrier. If the water from bathing is left to evaporate on the skin, it increases the amount of water lost through the skin, which is already out of balance with AD. Applying moisturizers soon after bathing and gently toweling the skin dry helps maintain good hydration in the skin. Moisturizers also help lessen the symptoms of AD, including itch, redness, cracks in the skin, and thickening of the skin (lichenification).3
For people with moderate to severe AD who have repeated skin infections, the addition of bleach to the bath a few times a week can be helpful to decrease the amount of bacteria on the skin’s surface and reduce the chance of infections. Bleach baths involve adding 2 teaspoons of bleach per gallon of water. (A typical bathtub holds between 25-40 gallons of water.) For a full bathtub, use ½ cup of bleach. For a half full tub, use ¼ cup of bleach. Regular strength bleach (6%) should be used – not concentrated bleach. Clinical studies have proven that bleach baths can reduce the bacteria found on the surface of the skin and reduce infections.3,4
Wet-wrap therapy, with or without a topical corticosteroid, is another technique that can help moderate to severe AD. Wet-wrap therapy involves applying the medication (if using) and wrapping the affected area in a layer of wetted gauze, cotton, or bandages, followed by a layer of dry bandages. Wet-wrap therapy helps improve the moisture of the affected skin, improves the penetration of the topical medicine, and provides a physical barrier against scratching.3
Soak and smear therapy
Soak and smear therapy involves soaking the affected area for 20 minutes, followed by application of an ointment. Some doctors may recommend doing soak and smear with a medicated ointment such as a topical steroid for a short period of time to treat acute flares of AD. Studies have shown that soaking and smearing can be effective techniques for managing skin conditions like AD.5