Atopic dermatitis (AD) is a chronic skin condition that affects close to 18 million people. It’s characterized by dry skin and a persistent itch. AD is a common type of eczema.
Finding a good prevention and treatment plan for AD is essential for managing symptoms. Untreated AD will continue to itch and lead to more scratching. Once you start scratching, you’re at greater risk of infection.
Effective treatment can help you maintain a higher quality of life and get better sleep. Both are essential for reducing stress, which can lead to increased flare-ups.
While there isn’t a cure for AD, there are different treatment options. These include over-the-counter (OTC) products, prescription medications, and phototherapy.
Many of the treatment options for AD are available without a prescription.
Moisturizing the skin is one of the simplest and most effective AD treatments. To relieve the dry skin caused by AD, you must add moisture to the skin. The best way to do this is to apply a moisturizer immediately after bathing, while the skin is still damp.
OTC moisturizers are a good long-term treatment solution. There are three different types of moisturizers:
Lotions are the lightest moisturizers. Lotion is a mix of water and oil that you can easily spread over the skin. However, the water in lotion evaporates quickly, so it may not be the best choice for severe AD.
A cream is a semisolid mixture of oil and water. The oil content is higher in cream than in lotion. Creams are more emollient than lotion, meaning that they better hydrate the skin. Creams are a great daily moisturizing option for chronically dry skin.
Ointments are semisolid greases with very high oil content and much less water than lotions and creams. Ointments are very moisturizing and should only have a few ingredients. The simplest ointment is petroleum jelly, which only has one ingredient.
Having very few ingredients makes ointments a good option for those with sensitive skin. Because these formulations feel greasy on the skin, it might be best to apply them before bed.
For short-term treatment, low potency topical corticosteroids are available over the counter. Low-strength hydrocortisone creams (Cortaid, Nutracort) are available at most drugstores and grocery stores.
You can apply hydrocortisone immediately after you moisturize your skin. It’s most effective for treating a flare-up.
The American Academy of Dermatology (AAD) recommends treating the affected area twice daily. Topical corticosteroids are not for long-term use. Instead, the AAD recommends occasional preventative use. Talk to your doctor about the possibility of using hydrocortisone one to two times per week on areas prone to flare-ups.
OTC oral antihistamines can supplement topical treatment of AD. According to the AAD, studies on the efficacy of antihistamines are mixed. Antihistamines aren’t generally recommended as a standalone treatment.
However, antihistamines like diphenhydramine (Benadryl) can help manage the itch-scratch cycle. The slight sedative effect may also help if your itching keeps you awake at night.
If you’re still fighting flares with OTC options, your doctor might write you a prescription. There are different types of prescription medications used to treat AD.
Prescription topical steroids
Most topical steroids are available only by prescription. Topical steroids are grouped by potency. They range from class 1 (strongest) to class 7 (least potent). Most of the more potent topical steroids aren’t suitable for children, so always consult with your child’s doctor first.
Topical steroids may be prepared as lotions, creams, or ointments that are applied to the skin. Like with moisturizers, ointments might be the best option if creams tend to cause burning or stinging.
Topical calcineurin inhibitors
Topical calcineurin inhibitors (TCIs) are a relatively new class of anti-inflammatory drug. They do not contain steroids. Yet they’re effective in treating the rash and itching caused by AD.
There are two prescription TCIs on the market today: pimecrolimus (Elidel) and tacrolimus (Protopic).
In 2006, the U.S. Food and Drug Administration (FDA) added a black box warning label to the packaging of these two medications. The warning alerts consumers of a possible link between TCIs and cancer.
The FDA admits that it will take decades of research to determine if there’s an actual proven risk. In the meantime, the FDA recommends that these medications only be used as second-line treatment options.
If your doctor determines that your AD isn’t responding to other treatments, they may consider short-term treatment with TCIs.
Another new medication was approved in 2017 by the FDA. Dupilumab (Dupixent), an injectable anti-inflammatory, can be used alongside of corticosteroids.
Topical prescriptions are the most common and most studied treatment for AD. On occasion, your doctor may prescribe oral medications such as:
- oral corticosteroids for widespread, severe, and resistant AD
- cyclosporine or interferon for severe AD
- antibiotics if you develop a bacterial skin infection
Phototherapy refers to treatment with light. Treatment with narrowband ultraviolet B (NB-UVB) light is the most common form of phototherapy for people with AD. Treatment with NB-UVB eliminates the skin damaging risks of ultraviolet A (UVA) light from sun exposure.
Phototherapy is a good second-line option if you aren’t responding to more standard treatment. It can also be used for maintenance treatment.
Cost and accessibility are two of the biggest detractors. You would need access to phototherapy treatment two to three times per week. This may require significant travel time and cost.
With all of these treatment options, you should be optimistic that you will find a way to manage your symptoms. Talk to your doctor about creating the best AD treatment plan for you. If your doctor writes you a new prescription, make sure to ask questions about proper use.