A Primer on Atopic Dermatitis

Atopic dermatitis (AD) is a chronic, inflammatory skin condition with symptoms ranging from dry, itchy skin to painful rashes that interfere with sleep and daily activities.¹ It affects 1 in every 10 Americans.¹ AD usually starts in early childhood; however, cases also are diagnosed in some adults.¹ It is estimated that 25% of children in the United States have AD compared with 10% of adults.² Study results have shown that African American and Asian populations are more likely to develop the disease.² Patients with AD can develop other autoimmune conditions; for example, asthma and hay fever are reported in more than half of children with eczema.³

Pharmacists can play a major role in educating patients on how to manage flare-ups and take preventive measures. The goal of the treatment is to enhance patients’ quality of life by reducing outbreaks, controlling symptoms, and lowering the risk of infection.¹

Patients should stay hydrated and apply moisturizer at least twice daily.⁴ Pharmacists should help patients learn to identify triggers that can cause skin irritations. Keeping a list of such triggers can help patients reduce skin flare-ups and better manage symptoms. Some triggers include stress, dry skin, detergent, fragrance, dye, and other chemicals.⁴

The first-line treatment for mild AD is a topical steroid (eg, hydrocortisone) that can be applied twice daily during flare-ups.⁴ Hydrocortisone is safe to use for patients 2 years and older. However, if symptoms have not been controlled within 7 days of treatment, seeing a dermatologist is recommended.⁴ Topical hydrocortisone is available over the counter at 1% strength. It can be used on almost all body areas for a short time. Oral first-generation antihistamine (eg, diphenhydramine) can help reduce itching.⁵

Some remedies for adults and children include the following⁶:

• Take a warm bath for no more than 10 minutes
• Use a mild, fragrance-free cleanser
• Pat skin gently to dry and apply petroleum jelly-based moisturizer after bathing
• Trim fingernails to avoid scratching and skin infection
• Keep room temperature at a comfortable level

Pharmacists should recommend a physician visit for moderate to severe cases of AD that involve intense itching, children younger than 1 year, infected skin, and facial flare-ups.⁴

If a patient’s condition is not controlled with OTC medications, a dermatologist or primary care physician can prescribe other medications to help lessen symptoms. The physician may prescribe more potent topical corticosteroids, topical calcineurin inhibitors, or crisaborole.⁵ Topical calcineurin inhibitors can be used on the eyelids, neck, and skin folds, whereas high-potency corticosteroids can cause skin atrophy when applied to these areas.⁵ Studies show that oral immunosuppressant cyclosporine may help in reducing AD symptoms, but recurrence is common after discontinuation.⁵

For severe cases, a dermatologist may recommend phototherapy, which includes using UV light 2 to 3 times per week for a few weeks or months.¹ Another option that a physician may recommend for moderate-to-severe eczema is the wet wrap therapy. Medication is applied, then a wet dressing is worn over the area and covered with a dry dressing.⁵ Wet wrap therapy can help calm the skin and reduce itching and scratching.⁵

Patients who fail other treatments and are not qualified to receive phototherapy may be prescribed dupilumab injection.⁷ Dupilumab is a human monoclonal antibody inhibiting IL-4 and IL-13 that is approved to treat AD in patients aged 6 years and older.⁷ Some patients may consider a bleach bath to prevent flare-ups by decreasing bacteria on the skin. Patients will be instructed to add half a cup of household bleach to 40 gal of warm water.³ Then the patients will soak from the neck down or just the affected areas of the skin for about 10 minutes.⁴ Bleach baths should not be taken more than twice a week.³

References

1. Eczema types: atopic dermatitis diagnosis and treatment. American Academy of Dermatology Association. Accessed December 19, 2020. https://www.aad.org/public/diseases/eczema/types/atopic-dermatitis/atopic-dermatitis-treatment
2. Eczema types: atopic dermatitis causes. American Academy of Dermatology Association. Accessed December 19, 2020. https://www.aad.org/public/diseases/eczema/types/atopic-dermatitis/causes.
3. Atopic dermatitis (eczema). Mayo Clinic. Accessed December 19, 2020. https://www.mayoclinic.org/diseasesconditions/atopic-dermatitis-eczema/symptoms-causes/syc-20353273
4. Krinsky, DL. Atopic dermatitis. Pharmacy Today. October 2019. https://www.pharmacytoday.org/action/showPdf?pii=S1042-0991%2819%2931140-5
5. Weston WL, Howe W. Treatment of atopic dermatitis (eczema). UpToDate. Updated September 24, 2020. Accessed December 20, 2020.
   https://www.uptodate.com/contents/treatment-of-atopic-dermatitis-eczema
6. Eczema types: atopic dermatitis: tips for coping. American Academy of Dermatology Association. Accessed December 19, 2020. https://www.aad.org/public/diseases/eczema/atopic-dermatitis-coping