By Dr Ananya Mandal, MD
There is no single cure for atopic dermatitis. However, there are several measures and medications that may help relieve the symptoms of the condition and prevent flare ups of atopic dermatitis.
Many infants and children with atopic dermatitis may find that their symptoms ease as they grow into adulthood. There are several preventive measures such as avoidance of the known triggers, keeping skin moist and preventing scratching that can reduce the frequency and severity of atopic dermatitis flare ups.
Medications that are used to treat atopic dermatitis include:-
Emollients or moisturizers
Emollients or moisturizers help prevent dry skin. Atopic dermatitis causes skin to become dry and cracked. The moisturization helps prevent this dryness.
There is a layer of fatty acids that prevent the water being lost from the outer layer of the skin, and add water to the skin acting as a protective barrier to keep the moisture in the skin and to prevent exposure to irritants.
Several different emollients are available that can be bought over the counter. Ointments are suitable for very dry skin while a cream or lotion is for less dry skin.
Emollients for face and hands are different for those used over the body. Emollients may also be added to bath water.
Most adults and children with atopic dermatitis require large amounts of emollients to keep their skin moist and prevent drying. The most common side effect of using emollients is stinging.
Corticosteroids are used over skin as ointments, lotions or creams. Topical corticosteroids are used in terms of a standard unit called the fingertip unit (FTU). A single FTU is the amount of cream that covers an adult’s finger tip. This amount is sufficient for treatment of an area as big as an adult hand.
Corticosteroids work by reducing skin inflammation. Topical corticosteroids are available as different preparations and strengths. The mild ones include hydrocortisone and moderate ones include clobetasone butyrate. Severe cases may require stronger agents.
Corticosteroids need to be applied as prescribed. In moderate to severe cases they may be prescribed between two flare ups as well.
Topical corticosteroids may cause a mild burning or stinging when applied. Over long term use they may cause thinning of the skin, visible blood vessels underneath, increased hair growth and acne.
Antihistamine medications are prescribed to relieve itching. Earlier used agents caused severe drowsiness. Nowadays low sedating agents like loratadine, terfenadine, acrivastine and cetirizine are prescribed.
In severe flare ups when topical or locally applied corticosteroids fail to provide relief oral corticosteroids may be added. Commonly used agent is oral prednisolone pills. These may be prescribed to be taken once a day for one to two weeks.
When the dermatitis areas are infected, antibiotics are prescribed. These are usually prescribed orally but may also be prescribed topically or to be applied locally as creams, ointments and lotions to prevent and treat infections.
Oral antibiotics commonly used include flucloxacillin, which is usually taken four times a day for seven days.
For those allergic to penicillin other agents such as erythromycin (four times a day for seven days) or clarithromycin (twice a day for seven days) may be prescribed.
Immunological suppressors like topical calcineurin inhibitors, such as pimecrolimus and tacrolimus are prescribed in severe cases. They suppress the local immunity and prevent allergic reactions leading to flare ups.
This is the first choice in patients with severe atopic dermatitis. A drug is administered to optimize the uptake of the phototherapy. Beams of UV-B (ultraviolet B) radiation of 311 nm wavelength are used.
Reviewed by April Cashin-Garbutt, BA Hons (Cantab)