Diagnosis and treatment of atopic dermatitis

Diagnosis and treatment of atopic dermatitis requires visiting a doctor who may refer a patient to a dermatologist. Currently there is no single test or system to diagnose the disease. Every patient experiences a unique combination of symptoms that may vary over time. The most valuable diagnostic tool is a thorough medical history and skin examination. Occasionally, it may be necessary to do a biopsy of the skin or patch testing to see if the skin's immune system overreacts to certain chemicals, preservatives or skin creams.

Partner with your doctor

Treatment involves a partnership among the patient, family, caregivers and doctor. Treatment plans are tailored to each patient and are based on age, severity, symptoms and general health. The dermatologist has three main goals with all patients: heal the skin, prevent and minimize future attacks and treat them properly when they do occur.

Healing the skin and keeping it healthy are imperative to both preventing further damage and enhancing a patient's quality of life. A daily skin routine is critical to minimizing exacerbations. It should include:

• Proper bathing in lukewarm water to minimize dryness
• Limited use of perfumed bath soaps
• Air or pat drying
• Use of lubricants such as creams and ointments within three minutes of bathing

Treatment options

If flares occur, doctors consider several methods dependent on the age of the patient and the severity of symptoms. An overview of methods include:

• Topical prescription steroid creams and ointments - These are the most frequently used treatments. Occasionally the base of the steroid medications is irritating. Side effects of repeated or long-term use of topical steroids are also of concern to doctors, patients and parents. Local effects may include:
  • Thinning of the skin
  • Dilated blood vessels
  • Stretch marks and infection
  If enough steroid is absorbed, affected children may show growth suppression and other signs of excessive steroids.
• Antibiotics for skin infections - These may be applied directly to the skin but typically are more effective if taken orally.

• Antihistamines - They can reduce night scratching, cause drowsiness and improve sleep.
• Phototherapy or treatment with ultraviolet A or B light waves - Together they can be effective treatment for mild to moderate dermatitis in adults and children over 12 years of age.
• Photochemotherapy or a combination of ultraviolet therapy and a drug called psoralen - These are sometimes used in teens and adults resistant to phototherapy.
• Oral or injectable steroids - When other treatments are not effective, the doctor may prescribe oral or injectable steroids. However, their side effects are of concern and can include:
  
  
  • Skin damage
  • Thinned or weakened bones
  • High blood pressure
  • High blood sugar
  • Growth suppression in children
  • Infections and cataracts

New treatment options

Scientists are focusing on identifying new treatments for atopic dermatitis including:

• Biologic agents such as interferon gamma and immune globulin G, which may help regulate allergic reactions
• Supplements to improve fatty acid deficiency and restore skin moisture and elasticity
• New forms of phototherapy
• Antibiotics to combat the Staphylococcus aureas infections often associated with atopic dermatitis

New forms of immunosuppressive drugs to treat immune dysfunction

New treatment options are on the horizon for the first time in more than 40 years. A new class of drugs called topical immunomodulators, or TIMs, show promise and will bring a unique, steroid-free treatment option to doctors, and hope for improved treatment satisfaction. Two TIMs are in development-tacrolimus and ascomycin-and are currently under consideration by the U.S. Food and Drug Administration. Tacrolimus ointment is likely to be the first TIM introduced in the United States for atopic dermatitis.

Phase III clinical trials involving more than 1,000 children and adults with eczema demonstrated that tacrolimus ointment improved or completely cleared eczema with a lower incidence of side effects than topical steroids in over 80 percent of the participants. TIMs work differently than steroids to relieve the itching, redness and pain of eczema. The are steroid-free and can be applied to all areas of the body including the face and the neck. The introduction of TIMs will help fill the current therapeutic void for physicians and their patients.