Atopic dermatitis is not a "one-size-fits-all" condition.
As a PA with over a decade of clinical dermatology experience, there are several things I wish my patients with atopic dermatitis understood. Here is a list of my top 10.
Your treatment is not a cure; therapy should not be discontinued once symptoms improve. Once the initial flare is controlled, your treatment plan will move to a maintenance plan, which will need to be continued daily. It is essential to build a strong relationship with your dermatology team so they can appropriately tailor therapy to you as needed. This disease will wax and wane over time and may even go into remission.
While you may have tried everything over the counter before coming to the clinic, you may have not tried them in combination with medications or even used them long enough. However, some studies support the use of cold-pressed or virgin coconut oil and sunflower oil. These are anti-inflammatory products that can keep the skin's natural barrier.1 Additionally, black tea compresses can improve symptoms. Ordinary ice packs can also decrease the itch sensation!
The Itch That Rashes
There is a reason it is called the itch that rashes. If you are itching, you are inflamed and are in need of therapy. Please do not wait to start treatment until the rash appears!
Emotions of Atopic Dermatitis
This skin disease comes with more than just skin inflammation, as itching may also alter sleep habits, impacting social aspects of life. It is important to communicate sleep disturbances to your health care team. Additionally, and more importantly, if atopic dermatitis is impacting the quality of life, therapy should be considered. Asking for help is not a sign of weakness!
Triggers Are All Around Us
Yes, that means you need to be picky with even your wardrobe. Yes, that includes even the nickel on the snap of your jeans! Wool can be irritating to the skin in addition to other fabrics. Sticking with cotton may help alleviate symptoms, but even environmental triggers such as fragrance and pollen can worsen itch symptoms.2 Stress can also trigger a flare and perpetuate disease as it negatively impacts the immune system. It is important to track your triggers.
There are several different types of therapy ranging from topicals, orals, injectables, light therapy, and antibacterial and antipruritic options. Therapy may evolve over time, or be used in combination as the needs of the disease can also change. Therapy options need to be used as prescribed and do not take the place of your daily moisturizer. This also encompasses not taking hot showers, as this can lead to further skin barrier disruption and therefore perpetuate your disease. Using lukewarm water for showering is advised.
Vitamin D and fish oil supplementation have beeen shown to be beneficial in several studies, however, results have varied. Meditation, massage, and even acupuncture have been shown to be beneficial in reducing pruritis.1 As mentioned above, black tea compresses and coconut oil have been successful for many patients. Several dermatologists utilize “pink cream” or a B12 compound which has also been effective. A key factor to atopic dermatitis management is to not try something one time and say it did not work, give it at least 30 days to see a benefit.
Moisturizing is incredibly important. Even when you are doing well, you should be utilizing a therapeutic moisturizer at least once a day after bathing. Work with your dermatology health care provider to select the best one for you. A study from 2015 revealed that daily use of emollients was the basis of therapy and can support the preservation and restoration of the skin's moisture.3 Patients need to understand that all moisturizers are not created equal and there is no “best” moisturizer. Instead, it is what works best for each individual patient based on their skin type and needs. Selecting moisturizers with ceramides, natural moisturizing factors, licorice extract, as well as pre and probiotics can aid in skin barrier restoration and protection from water loss. Additionally, your skin is naturally acidic, and therefore selecting a product to help maintain the skin's normal pH can decrease the risk of infections. Placing your moisturizer in the refrigerator can even further benefit your skin by decreasing itch.
Food: Friend or Foe?
While diet may be a controversial topic, there is scientific evidence that removing certain foods can improve symptoms via the gut-skin axis. Some studies and case reports have shown patient improvement with elimination diets including removing dairy products. There are several arms of the immune system and patients can have reactions to food that are non-allergic in nature. In addition, alterations in gut microbial concentrations can lead to immune activation and drive the disease. Some patients may even benefit from the daily use of oral prebiotics and probiotics to dampen the immune activation in the gut. More studies need to be done to determine appropriate strains of bacteria to confer benefits.
There is no One-Size-Fits-All Option
Lastly, just because something worked for a friend doesn’t mean it will do the same for you. There is no silver bullet and atopic dermatitis can evolve over time. Ultimately, patients may need a combination of different modalities to control their disease. Understanding treatment may need to evolve with you over time will aid in unmet expectations breeding frustration.
Wilchowski is a senior clinical educator for Boehringer Ingelheim.
1. Goddard AL, Lio PA. Alternative, Complementary, and Forgotten Remedies for Atopic Dermatitis. Evid-Based Complement Altern Med ECAM. 2015;2015:676897. doi:10.1155/2015/676897
2. Kantor R, Silverberg JI. Environmental risk factors and their role in the management of atopic dermatitis. Expert Rev Clin Immunol. 2017;13(1):15-26. doi:10.1080/1744666X.2016.1212660
3. Ridd MJ, Redmond NM, Hollinghurst S, et al. Choice of Moisturiser for Eczema Treatment (COMET): study protocol for a randomized controlled trial. Trials. 2015;16(1):304. doi:10.1186/s13063-015-0830-y