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Facts about the skin from DermNet New Zealand Trust. Topic index: A B C D E F G H I J K L M N O P Q R S T U V W X Y Z


Treatment of atopic dermatitis

Is there a cure for atopic dermatitis?

There is no known cure for atopic dermatitis (eczema). As a large part of the tendency towards eczema is genetic, there is unlikely to be a cure anytime in the foreseeable future. There is, however, ongoing research and very effective treatments.

Several treatments are available that will control the eczema so the skin looks and feels normal.

Topical treatments for atopic dermatitis

Most people with eczema use topical treatments (lotions, creams and ointments). When the surface of skin is inflamed, cracked or raw, many of these sting or burn when first applied. This irritation will lessen as the eczema improves. It is worth persevering for at least a few days. If the stinging persists beyond this or causes welts or the eczema gets worse, stop the treatment and consult your doctor.

Emollients

Emollients provide moisture to the skin and help prevent further water loss. They should be used in almost everyone with eczema in an attempt to restore skin barrier function. Emollients are a very important part of eczema management, even (especially) when the eczema is well controlled. Remove the emollient from the pot using a clean spoon to avoid contamination. Note: clothing soaked in paraffin-based emollients becomes a fire hazard.

Topical steroids

Topical steroids are the mainstay of treatment for mild to moderate eczema. They are also used in severe atopic dermatitis to reduce the dose of oral treatments and ultraviolet light. They are very effective and safe if used correctly. Despite this, many people are concerned about potential side effects from topical steroids. The trick is to use the correct strength of steroid for the severity of the eczema and be prepared to change treatment as the severity of the eczema changes.

As eczema tends to be persistent, most people will have to use topical steroids on and off for many years. If used continuously topical steroids may lose their effectiveness after a few weeks (this is known as tachyphylaxis). Tachyphylaxis can be avoided by reducing the strength and frequency of the topical steroid as the eczema comes under control.

Topical immunomodulators

The topical immunomodulators or calcineurin inhibitors pimecrolimus cream (Elidel™) and tacrolimus ointment (Protopic™, which is not yet available in New Zealand) are particularly useful for mild to moderate atopic dermatitis. They are antiinflammatory but do not thin the skin or affect its barrier function.

Antiseptic solutions

Antiseptic solutions can also be helpful in infected eczema as long as the concentration is not too high or they can have an irritant effect on the skin. Apply an emollient as well.

Tar preparations

Coal tar, pine tar and ichthammol preparations are available as creams, bandages and bath additives. Although reducing itch and inflammation, they can be smelly and messy and do not appear as effective as topical steroids.

Wet wraps

Wet wraps’ are wet bandages applied over emollients +/- topical steroids. Tubular elastic bandages are convenient. Wet wraps are used in acute red, hot, weeping eczema and usually require admission to hospital. They can quite quickly gain control of eczema and appear to work by cooling and moisturising the skin. They also protect the skin from damage due to scratching. They can be repeated for several days or longer, reapplied as they dry out.

Antibiotics in the treatment of atopic dermatitis

Oral antihistamines in the treatment of atopic dermatitis

Phototherapy for atopic dermatitis

Systemic treatments for atopic dermatitis

The following oral medications are reserved for severe eczema, usually after a trial of phototherapy has at least been considered.

Despite the potential long-term side effects of immunosuppressive agents, most patients who take them for severe eczema are very happy with the result as it frees them from otherwise disabling eczema. Immunosuppressant agents are not intended for indefinite use but if severe eczema relapses every time they are stopped they may be needed at least intermittently for many years.

In the future, it is anticipated that biologic medications will be developed for atopic dermatitis. To date, the biologics that are used to treat psoriasis have not been found to be effective for eczema. But rituximab, a B-cell antibody, shows promise. Unfortunately it has severe side effects and is not effective in every case.

Behavioural therapy for atopic dermatitis

Scratching damages the skin, aggravating the eczema, which then itches even more. Some scratching is just a bad habit or stress reaction. Behavioural therapy can be helpful to develop strategies to reduce scratching (habit reversal) thus leading to improvement in the eczema.

Unproven therapies used in atopic dermatitis

So-called cures for atopic dermatitis abound, with many examples found readily on the Internet. Most are ineffective. Some are potentially hazardous. Insufficient evidence exists to recommend probiotics, leukotriene inhibitors, essential fatty acids or traditional Chinese medicines.

Related information

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Author: Dr Amy Stanway, Department of Dermatology, Health Waikato, February 2004

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If you have any concerns with your skin or its treatment, see a dermatologist for advice.