Atopic dermatitis - all you can do from the outside

Abstract

Summary Atopic dermatitis (AD) affects both the epidermal barrier and the immune system and, as such, therapy needs to address both. Skin cleansing supported by emollients and moisturizers is the primary topical therapy when treating patients with AD. However, it should be remembered that the direct use of emollients on inflamed skin is poorly tolerated and that the flares need to be treated effectively, usually by topical corticosteroids (TCS) and/or topical calcineurin inhibitors (TCI). This contribution outlines a number of strategies for effectively managing AD, from reactive therapy using TCS and TCI to proactive therapy. Proactive therapy is an alternative, evidence‐based, immunologically founded treatment approach, based on the fact that normal‐looking, nonlesional skin of patients with AD is not normal. The advantage of the proactive approach is that the patients are in control of their disease and are actively involved in its management. The avoidance of external irritants is recommended wherever possible.

ETFAD/EADV Eczema task force 2015 position paper on diagnosis and treatment of atopic dermatitis in adult and paediatric patients

“…Cleansers with or without antiseptics in non‐irritant and low allergenic formulas may be used, and are available in various galenic forms such as syndets or aqueous solutions. As the duration of action of some antiseptics is very limited, mechanical cleansing is probably more important . The pH should be in a physiological cutaneous range around 5–6.…”

“…European experts had recommended to bath no more than three times weekly especially in newborns, but a recent prospective trial comparing twice weekly vs. once daily bathing found that the bathing frequency is unimportant as long as hydration of the skin is achieved . Topical emollients are preferentially applied directly after a bath or a shower following gentle drying when the skin is still slightly humid . Although bathing seems very important, there is lack of good evidence to prove its effectiveness.…”

Methylprednisolone aceponate for atopic dermatitis

“…This seems reasonable in view of the recent knowledge that primarily skin barrier defects are the origin of AD. However, whereas the use of emollients is beneficial for patients with controlled AD and in the areas not affected by eczema, it is the author's experience, as well as others’, that the direct application of emollients on the skin affected with eczema is poorly tolerated and causes itch and irritation . In the author's opinion, atopic eczema should be brought into control before emollients are liberally used, and for this, pharmacological therapy is necessary.…”

Pregnancy complications, treatment characteristics and birth outcomes in women with atopic dermatitis in Denmark

“…3 There is a little insight in the natural course of AD during pregnancy, and in particular the use of dermatologic therapy. [4][5][6][7][8] Emollients and topical corticosteroids remain first-line recommended therapy for AD during pregnancy, 9 while narrowband ultraviolet (UV) B therapy and cautious use of systemic corticosteroids represent alternatives when more aggressive therapy is needed. 5,10,11 However, pregnancy does not improve the largely unfavourable risk-benefit ratio of long-term systemic steroid treatment for AD.…”