Treatment for Atopic Dermatitis
Management of atopic dermatitis includes treating the various aspects of this disease. Because atopic skin is often quite dry and irritated, emollients are a mainstay of treatment. Daily baths or showers, followed immediately by the application of moisturizers, helps to restore the protective skin barrier.
Crusted and oozing areas respond to wet, lukewarm water compresses or a weak aluminum acetate solution. Bath oils lubricate dry areas, but care should be taken with young children because oils can make the bathtub slippery. Bubble baths should be avoided because they irritate the skin.
Cigarette smoking should not be allowed in homes where there is a family member suffering from atopic dermatitis, and pets should be kept outdoors as much as possible. Regular dusting of furniture and vacuuming of carpets and drapes are recommended.
Soft cotton clothing is preferable to wool, which can irritate the skin and trigger a flare-up. In summertime, air conditioning helps. In the winter, heated dry air can exacerbate the condition, so moisturizers should be applied frequently.
If dietary causes are suspected, a trial of eliminating certain foods can be attempted. In general, food sensitivities diminish or resolve by age 5.
Corticosteroid creams and ointments often are prescribed for the itch and rash. These formulations are applied to the affected areas only, and weaning the patient off of them periodically helps to minimize their side effects. Given the widespread use of cortisone creams, reports of side effects are surprisingly few, but they include thinning of the skin, stretch marks, telangiectases (broken blood vessels) in the underlying skin, and, sometimes, systemic absorption. Weaker formulations of these creams are used on the face and in skin folds, and stronger preparations are used on thickened skin.
Oral corticosteroids such as prednisone sometimes are used for severe flare-ups.
Topical anti-itch lotions and oral antihistamines also help control itching. Tar solutions that help relieve itching and inflammation can be applied to the skin or added to the bath. In extensive and chronic cases, ultraviolet-light treatments may be administered in the doctor's office.
Preliminary studies with topical tacrolimus ointment have been very encouraging. This medication will become widely available in 2001. Tacrolimus is an immune-suppressing agent used systemically in liver transplant patients. Topical formulations have proven to cause fewer side effects than oral and injectable forms of the medication.
Atopic Dermatitis Prevention
Persons with atopic dermatitis can prevent flare-ups by avoiding exacerbating factors such as excessive perspiration and dryness of the skin, irritating fabrics such as wool, irritating soaps and detergents, and, in a small number of children, certain foods.
Supplementation with essential fatty acids, particularly evening primrose oil, can help minimize inflammation in the skin. Both topical and oral aloe vera are also useful.