Atopic dermatitis (A.D.) is a chronic inflammatory skin disorder. It affects approximately 11% of the U.S. population with a higher prevalence in children less than 5 years old. Most studies show that A.D. results from an impaired skin barrier due to intrinsic structure and functional abnormalities.
Other studies suggest an immune function disorder in certain skin cells (Langerhan, T-cell and immune effector cells) causing an inflammatory response to environmental factors. Abnormalities of the skin barrier leads to increased water loss, and dry skin contributes to itching and scratching. This skin trauma causes release of pro-inflammatory mediators, which worsen the itching sensation. This creates an “itch-scratch” cycle which causes Atopic Dermatitis to persist or worsen. Staphylococcus Aureus may complicate A.D. as a super-infection and require additional treatment. Treatment starts with:
A) Eliminating potential triggers. These may include:
- Detergents (use hypoallergenic)
- Fabric softeners
- Dryers sheets
- Soaps (use mild unscented) we recommend Dove or Lever 2000
- Perfumes and other chemicals
- Heat, perspiration, low humidity
- Stress and anxiety
- Dust mites
- Pet and food allergens
- Irritating and tight fitting clothing
B) Maintain skin hydration:
Eucerin/Ceptaphil/Vanicream as well as Vaseline or petroleum jelly are just a few examples of over the counter remedies. Emollients applied just after bathing and showering may help to keep your skin well hydrated. We recommend bathing several times a week.
C) Control itching:
Antihistamines can be used for sedation as well as minimizing scratching.
D) Inflammation control:
Topical corticosteroids are the mainstay of therapy. More potent tropical steroids may be needed to control an exacerbated state. Milder steroids may then be substituted in once better control is maintained. Systemic steroids (oral or injectable) may be needed for bad flare-ups. Topical calcineurins (Elidel/Protopic) may be used in some patients. This non-steroidal does not affect pigmentation and therefore may be preferred on the face. All topical anti-inflammatory medications have potential side effects which need to be outweighed by their benefits. These treatments should be used sparingly. Antibiotics therapy (topical versus systemic) may be beneficial in patients with bacterial super infection. This is usually apparent with excessive redness as well as oozing and crusting.
E) Other therapies:
- Immunotherapy for environmental allergens have been proven to be effective in some patients with documented sensitivity. At this time strict food avoidance is the only treatment for food allergic patients who experience worsening AD after a food trigger. Future therapy with food desensitization may be available in the next few years.
- Phototherapy with PUVA, not recommended for pediatric patients.
- Oral cyclosporine therapy should be considered for patients non-responsive to therapies mentioned above.
- Probiotic dietary supplements and Chinese herbal medicines are all considered controversial.
- Bleach baths (1/4-1/2 cup Clorox bleach) in a 40 gallon (standard) bath tub with luke warm water x 5-10 minutes 2-3x/week has been proven to be effective especially in patients with super infection. Fresh water rinse, patting dry and immediate emollient application after bathing is recommended.
- Treated documented viral and or fungal skin conditions may also be beneficial.