Treatment involves a partnership among the patient, family
members, and doctor. The doctor will suggest a treatment plan based
on the patient's age, symptoms, and general health. The patient and
the patient's family play a large role in the success of the
treatment plan by carefully following the doctor's instructions.
Some of the primary components of treatment programs are described
below. Most patients can be successfully treated with proper skin
care and lifestyle changes and do not require the more intensive
The doctor has three main goals in treating atopic
- Healing the skin and keeping it healthy
- Preventing flares
- Treating symptoms when they do occur
Much of caring for the skin and preventing flares has to do
- Developing skin care routines
- Identifying factors that make symptoms worse
- Avoiding circumstances that trigger the skin's immune system
and the itch-scratch cycle.
It is important for the patient and his or her family to note
any changes in skin condition in response to treatment, and to be
persistent in identifying the most effective treatment
Bathing and applying lubricants
Healing the skin and keeping it healthy are of primary
importance as part of both preventing further damage and enhancing
quality of life. Developing and sticking with a daily skin care
routine is critical to preventing flares. Key factors are proper
bathing and the application of lubricants, such as creams or
ointments, within three minutes of bathing. People with atopic
dermatitis should avoid hot or long (more than 10 to 15 minutes)
baths and showers. A lukewarm bath helps to cleanse and moisturize
the skin without drying it excessively. Because soaps can be drying
to the skin, the doctor may recommend limited use of a mild bar
soap or nonsoap cleanser. Bath oils are not usually helpful.
Once the bath is finished, the patient should air-dry the skin,
or pat it dry gently (avoiding rubbing or brisk drying), and apply
a lubricant immediately. Lubrication restores the skin's moisture,
increases the rate of healing, and establishes a barrier against
further drying and irritation. Several kinds of lubricants can be
used. Lotions have a high water or alcohol content and evaporate
more quickly, so they generally are not the best choice. Creams and
ointments work better at healing the skin. Tar preparations can be
very helpful in healing very dry, lichenified area. Whatever
preparation is chosen, it should be as free of fragrances and
chemicals as possible.
Avoiding and treating skin infections
Another key to protecting and restoring the skin is taking steps
to avoid repeated skin infections. Although it may not be possible
to avoid infection altogether, the effect of an infection may be
minimized if it is identified and treated early. People with atopic
dermatitis and their families should learn to recognize signs of
skin infections, including tiny pustules (pus-filled bumps) on arms
and legs, appearance of oozing areas, or crusty yellow blisters. If
symptoms of a skin infection develop, the doctor should be
consulted and treatment should begin as soon as possible.
- Give brief, lukewarm baths.
- Apply lubricant immediately following the bath.
- Keep child's fingernails filed short.
- Select soft cotton fabrics when choosing clothing.
- Consider using antihistamines to reduce scratching at
- Keep the child cool; avoid situations where overheating
- Learn to recognize skin infections and seek treatment
- Attempt to distract the child with activities to keep him or
her from scratching.
If a flare of atopic dermatitis does occur, several methods can
be used to treat the symptoms. The doctor will select a treatment
according to the age of the patient and the severity of the
symptoms. With proper treatment, most symptoms can be brought under
control within three weeks. If symptoms fail to respond, this may
be due to a flare that is stronger than the medication can handle,
a treatment program that is not fully effective for a particular
individual, or the presence of trigger factors that were not
addressed in the initial treatment program. These factors can
include a reaction to a medication, infection, or emotional stress.
Continued symptoms may also occur because the patient is not
following the treatment program instructions.
Corticosteroid creams and ointments
Corticosteroid creams and ointments are the most frequently used
treatment. Sometimes over-the-counter preparations are used, but in
many cases the doctor will prescribe a stronger corticosteroid
cream or ointment. The doctor will take into account the patient's
age, location of the skin to be treated, severity of the symptoms,
and type of preparation (cream or ointment) when prescribing a
medication. Sometimes the base used in certain brands of
corticosteroid creams and ointments is irritating for a particular
patient. Side effects of repeated or long-term use of topical
corticosteroids can include thinning of the skin, infections,
growth suppression (in children), and stretch marks on the
Antibiotics, antihistamines and antifungal
Some treatments reduce specific symptoms of the disease.
Antibiotics to treat skin infections may be applied directly to the
skin in an ointment, but are usually more effective when taken by
mouth. Certain antihistamines that cause drowsiness can reduce
nighttime scratching and allow more restful sleep when taken at
bedtime. This effect can be particularly helpful for patients whose
nighttime scratching makes the disease worse. If viral or fungal
infections are present, the doctor may also prescribe medications
to treat those infections.
Phototherapy and photochemotherapy
Phototherapy (treatment with light) that uses ultraviolet A or B
light waves, or both together, can be an effective treatment for
mild to moderate dermatitis in older children (over 12 years old)
and adults. Photochemotherapy, a combination of ultraviolet light
therapy and a drug called psoralen, can also be used in cases that
are resistant to phototherapy alone. Possible long-term side
effects of this treatment include premature skin aging and skin
cancer. If the doctor thinks that phototherapy may be useful to
treat the symptoms of atopic dermatitis, he or she will use the
minimum exposure necessary and monitor the skin carefully.
When other treatments are not effective, the doctor may
prescribe systemic corticosteroids. These drugs are taken by mouth
or injected into muscle instead of being applied directly to the
skin. An example of a commonly prescribed corticosteroid is
. Typically, these medications are used only in
resistant cases and only given for short periods of time. The side
effects of systemic corticosteroids can include:
- Skin damage
- Thinned or weakened bones
- High blood pressure
- High blood sugar
It can be dangerous to suddenly stop taking corticosteroids, so
it is very important that the doctor and patient work together in
changing the corticosteroid dose.
In adults, immunosuppressive drugs, such as
are also used to treat severe cases of atopic dermatitis that have
failed to respond to any other forms of therapy. Immunosuppressive
drugs restrain the overactive immune system. The side effects of
cyclosporine can include:
- High blood pressure
- Kidney problems
- Tingling or numbness
- A possible increased risk of cancer and infections.
There is a risk of relapse after the drug is stopped. Because of
their toxic side effects, systemic corticosteroids and
immunosuppressive drugs are used only in severe cases and then for
as short a period of time as possible. Patients requiring systemic
corticosteroids should be referred to dermatologists or allergists
specializing in the care of atopic dermatitis. They can help
identify trigger factors and alternative therapies.
In rare cases, when no other treatments have been successful,
the patient may have to be hospitalized. A 5- to 7-day stay in the
hospital allows intensive skin care and reduces the patient's
exposure to irritants and allergens and the stresses of day-to-day
life. Under these conditions, the symptoms usually clear quickly if
environmental factors play a role or if the patient is not able to
carry out adequate skin care at home.
A number of promising experimental medications are being tested
for atopic dermatitis. These medications affect the immune system
and offer additional options for patients with difficult-to-treat
symptoms. Researchers are also actively pursuing the development of
alternative treatments for atopic dermatitis.
- Provide complete, accurate medical information about yourself
or your child.
- Make a list of your questions and concerns in advance.
- Be honest and share your point of view with the doctor.
- Ask for clarification or further explanation if you need
- Talk to other members of the health care team, such as nurses,
therapists, or pharmacists.
- Don't hesitate to discuss sensitive subjects with your
- Discuss changes to any medical treatment or medications with
your doctor before making them.
Despite the symptoms caused by atopic dermatitis, it is possible
for people with the disorder to maintain a high quality of life.
The key to quality of life lies in education, awareness, and
developing a partnership among patient, family, and doctor. Good
communication is essential, both within the family and among the
patient, the family, and the doctor. It is important that the
doctor provide understandable information about the disease and its
symptoms to the patient and family. He or she should demonstrate
any treatment measures recommended to ensure that they will be
properly carried out.
When a child has atopic dermatitis, the entire family may be
affected. It is important that families have additional support to
help them cope with the stress and frustration associated with the
disease. The child may be fussy and difficult, and often is unable
to keep from scratching and rubbing the skin. Distracting the child
and providing as many activities that keep the hands busy is key,
but requires much effort and work on the part of the parents or
caregivers. Another issue families face is the social and emotional
stress associated with disfigurement caused by atopic dermatitis.
The child may face difficulty in school or other social
relationships and may need additional support and encouragement
from family members.
Adults with atopic dermatitis can enhance their quality of life
by caring regularly for their skin and being mindful of other
effects of the disease and how to treat them. Adults should develop
a skin care regimen as part of their daily routine, which can be
adapted as circumstances and skin conditions change. Stress
management and relaxation techniques may help decrease the
likelihood of flares due to emotional stress. Developing a network
of support that includes family, friends, health professionals, and
support groups or organizations can be beneficial. Chronic anxiety
and depression may be relieved by short-term psychological
Recognizing the situations when scratching is most likely to
occur may also help. For example, many patients find that they
scratch more when they are idle, so structured activity that keeps
the hands occupied may prevent further damage to the skin.
Occupational counseling also may be helpful to identify or change
career goals if a job involves contact with irritants or involves
frequent hand washing, such as kitchen work or auto mechanics.
Controlling atopic dermatitis
- Prevent scratching or rubbing whenever possible.
- Protect skin from excessive moisture, irritants, and rough
- Maintain a cool, stable temperature and consistent humidity
- Limit exposure to dust, cigarette smoke, pollens, and animal
- Recognize and limit emotional stress.