What is Atopic Dermatitus? (AD)

Patients with AD have a lowered threshold of irritant responsiveness. Thus recognition and avoidance of irritants are integral to successful management of this disease process. These irritants include detergents, soaps, chemicals, pollutants, abrasive materials and extremes of temperature and humidity.

1. Soaps should have a minimal de-fatting activity and a neutral pH. Mild soaps include Dove and Oil of Olay sensitive-skin formulations.

2. New clothing should be laundered before it is worn to reduce the content of formaldehyde and other chemicals.

3. Residual laundry detergents in clothing can be irritating. Using a liquid detergent and adding an extra rinse cycle is beneficial.

4. Occlusive (tight fitting) clothing should be avoided.

5. Cotton and cotton blend clothing is recommended.

6. Temperature at home and work place should be temperate to minimize sweating.

7. Swimming is well tolerated; however, because swimming pools are treated with chlorine or bromine, it is important for patients to shower and use mild soap immediately after to remove potentially irritating chemicals. After that, use moisturizing lotions or occlusive (e.g., Vaseline).

8. Prolonged sun exposure can cause evaporative loss, overheating and sweating, leading to irritation.

Allergen Avoidance

In many patients, especially children, food allergy can be a contributing factor. Allergy can be tested by your doctor. In children who have undergone appropriate testing, milk, egg, peanut, soy, wheat and fish account for approximately 90% of the food allergens found to exacerbate AD.

Environmental control measures to reduce the exposure to dust mite allergens can be of help. Your doctor will discuss these issues further if the testing indicates sensitivity.

Dealing with Psychological Factors

AD is often associated with extreme frustration. Unfortunately, stress can increase inflammation of AD. Relaxation, behavioral modification and biofeedback can be of benefit, especially in patients with habitual scratching.

Keep the Skin Hydrated

Skin of AD patients cannot retain moisture due to broken skin barrier. So, hydration is an essential component of therapy. The best way to re-establish the skin's barrier is to soak the affected area or bathe for 15-20 minutes and then apply an occlusive agent (Vaseline) to retain the established water. It is essential to use occlusive preparation immediately after soaking or bathing. Hydration of the facial areas can be done by applying a wet face cloth to involved areas for 15-20 minutes followed by application of occlusive agent.

Emollients

Emollients can come as moisturizing lotion, cream or ointments. Use fragrant-free products liberally as needed to keep the skin moist.

Probiotics

Evidence is emerging that the use of probiotics does have a salutary effect by reducing inflammation. Discuss with your doctor if you want to pursue this further.

Medications

Commonly used medicines for AD include:

• Systemic and topical corticosteroids
• Topical calcineurin inhibitors
• Antihistamines
• Anti-infective therapy

Photo-therapy and Photo-chemotherapy can be a useful modality in certain patients. This special kind of treatment is done by dermatologists.