Atopic dermatitis is one of the more common skin diseases that dermatologist see on a regular basis. It fits in the category of skin diseases commonly known as eczema. It includes many types of skin concerns, including dyshidrotic eczema, contact dermatitis, hand eczema, foot eczema, and what has recently received the most buzz, atopic dermatitis.

Most patients with atopic dermatitis usually have a family history of atopy. A triad which consists of atopic dermatitis (the rash), a personal or family history of allergies or hay fever, and a personal or family history of asthma. One does not need to have all three either personally or from the family history to be diagnosed with atopic dermatitis. Atopic dermatitis affects all ages, and in children may be found on the face, neck, or scalp. As one gets a little older, the more defined characteristics of the disease show in what we describe as the flexor creases of the skin, most commonly in the arms, legs, and on the neck. The patches of disease are usually red, or erythematous, and can also be scaly. Itching, which is known as pruritus, is one of the hallmarks of atopic dermatitis. It can be very discerning to many suffering from atopic dermatitis. Itching and scratching often leads to excoriations in the areas of the skin disease and can lead to infection and other concerns.

One of the things that has been interesting to observe as a dermatologist is that many who develop atopic dermatitis in their infancy may “outgrow” the symptoms when they turn 10-12 years of age. Those that do not will have signs and symptoms of the disease throughout their adult life. Predicting who will fall into this category, however, is not known. We need to advise patients and their families that these patients will need to be treated for an extensive period of time.

So how do we treat patients with atopic dermatitis? There are many different approaches and they should all begin with basic skin care and skin care precautions. The precautions include utilizing products and detergents that will touch the skin that are unscented. This is something that we must educate our patients on. They must be utilizing unscented soaps, detergents, and unscented dryer sheets. To take this one step further, we recommend that parents with young ones with the disease have unscented clothing, bedding, and bath towels as well. These young patients like to be held and placed on the beds of their parents, which can potentially trigger flaring of the atopic dermatitis. Dermatologists also recommend that all of the soaps that are used for these patients be mild, soap-less cleansers, and the most recommended brands are Cetaphil and CereVe. Both of these companies make cleansers for infants and for adults, and we recommend that our patients use them regularly.

We are asked regularly about bathing and what is the best way for our patients to bathe who suffer from atopic dermatitis. This is an interesting topic because most patients with atopic disease love taking long, hot showers and baths. It makes them feel good, but in actuality, this is very drying to the skin. We recommend that daily bathing done with warm water is fine. Showers and baths should be, what I call “in and out” so that they do not over dry the skin. Once out of the shower or bath, the skin should be patted dry only. After bathing, one needs to moisturize the skin and it should be done many times during the day. Again, the two main products that dermatologists recommend are Cetaphil and CereVe. Each brand has unscented moisturizing creams and lotions. We tell our patients that they need to apply their unscented moisturizer as often as they can, especially after bathing and having the skin patted dry.

Our patients come to the dermatologist when the “rash” is not controlled with the skin care steps outlined above. It is up to the dermatologist to assess the skin rash and to determine what steps are necessary from a medical point to “clear” the patient – to get them disease and symptom free. For most dermatologists, topical corticosteroids (TC) are the mainstay of treatment for our patients with atopic dermatitis. We use TC to control the inflammatory component of the disease and we know these medicines also control the associated itch we see with patients with atopic dermatitis. We need to be careful not to “overuse” TC as there are side effects which can be seen including thinning of the skin, which can be concerns later in life. We also need to choose our TC wisely. Some may be appropriate for the face and groin areas, but are not strong enough to control the disease. We do use stronger TC on the body when needed and when age-appropriate. Again, this may all sound confusing, but TC need to be used wisely and correctly, and that is why dermatologists are best suited to treat these patients suffering from atopic dermatitis. We also have several calcineuron inhibitors when used topically, can improve the signs and symptoms of atopic dermatitis. These topical medications are steroid free and have been shown to be safe in young and old patients who may benefit from them. Recently the U.S. market was introduced to topical criasbarole, the first topical phosphodiesterase-4 inhibitor. It is approved for our atopic dermatitis patients 2 years and older. This medicine is the first “boron” containing topical, which is now approved for the treatment of atopic dermatitis and again, is a non-steroid topical. Criasbarole has shown its effectiveness alone or in combination with our TS, although the FDA approval was with criasbarole alone.

And now, since we know atopic dermatitis is a chronic disease, we have the first FDA cleared “biologic” approved for moderate to severe atopic dermatitis, known as dupilumab. This is a monoclonal antibody targeted treatment that is available for the patients to self-inject, and reserved for those with atopic dermatitis, which is not responding to traditional therapy or interfering with the daily performance of everyday living. In our experience with this new subcutaneous injectable drug, we have seen lives transformed and we are thankful to have this new drug available for our patients.

Atopic dermatitis is a very common skin concern. With basic skin care steps and the medicines that are now available, patients can successfully treat their disease. More and more biologic medicines are in the research pipeline, so we expect even more, and perhaps, even better therapies in the not too distant future.