What Treatment Options Are There For Atopic Dermatitis?

Atopic dermatitis (AD) is the most common form of eczema and most often occurs in infancy or childhood. While many people with AD experience remission, the chronic condition can last into adulthood, and in rare cases, it can begin in adulthood.1,2

AD can be a frustrating condition for both the patient and their parents, as the symptoms, including an intense itching, redness, oozing, and scaling, can flare-up and recur again and again. AD causes damage to the skin barrier, and this damage interferes with the skin barrier’s normal functions of protecting the body against germs and keeping needed water in. There is also a dysfunction in the immune system in people with AD, which leads to increased inflammation on areas of skin affected by AD.1

Treatment goals involve relieving symptoms of AD, reducing the inflammatory response, repairing and maintaining a healthy skin barrier, controlling itch, and managing infectious triggers.1

Types of treatment for atopic dermatitis

Treatment for AD usually involves therapies that are targeted and applied to the skin directly. In addition to medications, a critical part of treating and preventing relapses of AD is good routine skin care. Routine skin care involves bathing and moisturizing the skin, as well as avoiding skin irritants and scratching. Daily bathing or showering can help hydrate the skin as well as remove any bacteria or other microorganisms that can cause infection.

People with AD are at a greater risk of infection due to the damage to the skin barrier and scratching, which can further break the skin and introduce microorganisms. The regular use of moisturizers is one of the most important aspects of caring for skin with AD. Moisturizers are one of the basic necessities for people with AD, regardless of the severity of their disease, and should be applied after bathing to seal in moisture.3,4

Medication options

In addition to routine skin care, there are several medications for AD, including topical corticosteroids, calcineurin inhibitors, topical phosphodiesterase-4 inhibitors (pde4), antibiotics, antihistamines, systemic corticosteroids, immunomodulators and cytokine therapies.

Topical corticosteroids

Corticosteroids are available in a range of potency, with more potent medications being available only by prescription and milder formulations available for purchase over-the-counter. Corticosteroids decrease inflammation and reduce the activity of the immune system.5

Topical calcineurin inhibitors

Topical calcineurin inhibitors block cytokines (chemical messengers) that trigger the inflammatory response.6

Topical phosphodiesterase-4 inhibitors (pde4)

Topical phosphodiesterase-4 inhibitors increase the levels of a chemical messenger called cyclic adenosine monophosphate (cAMP). This chemical suppresses the immune response.7,8

Antibiotics

Since people with AD are at a higher risk of infections, antibiotics (topical or systemic) may be prescribed to treat bacterial infections.6

Antihistamines

Antihistamines block the release of histamines, a protein that is released by the body’s immune system as part of an allergic reaction in response to an antigen. The primary function of histamine is to increase blood flow and nerve activity, which causes redness, rash, and itching, however, antihistamines have been found to have little effect in treating AD.6

Systemic corticosteroids

Systemic corticosteroids are medications that may be used to treat severe AD flares. Although systemic corticosteroids can rapidly improve symptoms of AD, experts caution that their use should be time-limited and well thought-out because of the potential side effects and possible disease rebound after discontinuation.9

Immunomodulators

Immunomodulators are a systemic treatment that suppress or interfere with the immune system response and may indirectly improve the function of the skin barrier and reduce the symptoms of AD, including itching, redness, and rash. There are several different immunomodulators that may be used in the treatment of AD.9,10

Cytokine therapies

Cytokine therapies target the immune system response and are typically used in severe AD cases.

Additional treatment options

Additional treatment options can include phototherapy. Phototherapy is the use of ultraviolet light waves as a treatment.9 There are some complementary and alternative treatment options that may help with symptom relief and improving quality of life.

Stopping the atopic march

The “atopic march” is a concept that atopic dermatitis is the first step in a progression of other allergic disorders, such as asthma, allergic rhinitis, and food allergy. Some researchers have suggested that early and successful treatment of AD may prevent or lessen the development of other atopic conditions.1

Emily Downward | June 2016
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