Severe atopic dermatitis is a more common condition than you would imagine. Treatments to cope with it that can be topical, with creams, medications or phototherapy.
Treatments for atopic dermatitis can lessen the symptoms of severe itching and redness. In addition, this pathology presents with colored plaques with vesicles, marked skin folds and scales, according to the stage of evolution in which it is found.
It manifests itself with outbreaks that appear and resolve intermittently throughout life. An article published in the Annals of Nutrition & Metabolism details that almost 20% of the pediatric population suffers from it. There are different therapeutic options. Do you know which ones they are? We detail them below.
Treatments for severe atopic dermatitis
Atopic dermatitis is not curable and many patients will experience a chronic course of the pathology. Consequently, treatment aims to reduce the duration and degree of the rash, if it occurs, as well as minimize the number of outbreaks.
Emollients
The use of emollients in the treatment of atopic dermatitis is a fundamental part. You must apply them several times a day. A review in the American Journal of Clinical Dermatology has shown that their consistent use reduces the need for corticosteroid creams.
The main reason for the intensive use of an emollient is its ability to increase the hydration of the epidermis, especially by reducing evaporation, since it acts as an occlusive layer on top of the skin.
Recommendations are to use a thick, high-fat cream or ointment for drier skin. On the other hand, you can use creams and lotions with a higher water content only for very mild eczema. It is important that this choice prefers the absence of perfumes and other potential allergens, as they can cause secondary allergic sensitization.
Topical corticosteroids
Topical corticosteroids are the mainstay of treatment for moderate and severe atopic dermatitis. In both children and adults, they are a valid option. They are grouped hierarchically into different classes according to their vasoconstrictor capacities, that is, their power to reduce the caliber of the arteries. Preparations can be mild, moderate, strong and very strong
You can use corticosteroid creams to treat acute flare-ups of atopic dermatitis, as well as for maintenance therapy. That is, they act to prevent relapses of the disease when the acute outbreak is under control.
According to the British Medical Journal, a daily application of the cream is recommended to treat acute flare-ups at the lowest potency considered sufficient to clear eczema in 1 to 2 weeks. Always the beginning of the approaches respects the progression from minor to major.
Calcineurin inhibitors
Pimecrolimus and tacrolimus creams are newer formulations for the treatment of acute flare-ups as well as for maintenance therapy. According to studies in the Journal of Dermatological Science, in moderate to severe atopic dermatitis topical tacrolimus is as effective as moderately potent corticosteroids and more effective than mild ones.
Corticosteroid side effects, such as thinning of the skin, cannot happen with topical calcineurin inhibitors. This allows daily application for longer periods.
Phototherapy as a treatment for atopic dermatitis
Generalized eczema benefits from ultraviolet light treatment. Narrowband UVB light is suitable for treating adults with recalcitrant eczema.
Broadband UVA light can also be used and demonstrates an efficacy and tolerability profile similar to narrowband UVB, according to publications from the Spanish Academy of Dermatology and Venereology. At medium doses, UVA phototherapy has a similar efficacy and tolerability profile to narrow-band UVB.
Difficult-to-treat atopic dermatitis often disappears with phototherapy for 1 to 2 months, if you have sessions three to five times a week. It is common to combine it with topical corticosteroids.
Systemic immunosuppressants
Due to the risk of side effects, prolonged treatment with oral corticosteroids is not recommended. Instead, Drugs indicates in a review that it should be tapering off while introducing a second immunosuppressive drug for very severe chronic relapsing atopic dermatitis.
Other medications
Oral antihistamines are recommended to relieve itching, but they have no effect on eczema activity. You should use non-sedating antihistamines, although when night itching interferes with sleep, the others are better.
The difference is the drowsiness that appears as an adverse effect in several of these drugs. In any case, in patients with difficulties to rest, they can be helpful.
Treatment of severe atopic dermatitis: what to watch out for?
The treatment of atopic dermatitis requires an individual and complex approach. Management of triggers is essential, as well as proper hygiene habits.
Doctors should tailor topical or systemic treatments to the severity and extent of the disease. For this, it is essential to make the relevant consultation with the professional in dermatology.
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