Atopic Dermatitis is commonly referred to eczema. Of the people with this condition, 85% start in childhood and 25% of those will continue to have flares throughout adulthood. 90 % of cases will be mild to moderate. The areas of skin effected can include the face, scalp and neck, with greater involvement in adulthood in areas of flexion (inside the elbows and behind the knees) as well as hands and ankles. The intense itch that accompanies the the red irritated skin has a large impact on quality of life, causing sleep disturbance, anxiety and depression.
The condition is as a result of genetic factors leading to a defect in the skin barrier allowing allergens, bacteria and viruses to penetrate through the skin. This generates an immune response causing excess inflammation along with histamine release. When not treated well in young children, this sensitization referred to as atopy, can lead to the development of asthma and allergic rhinitis.
Treatment strategies include twice daily application of a perfume-free moisturizer (vaseline works well along with moisturizers certified by the Canadian Dermatology Association). Using warm baths and showers, soapless cleansers, humidifiers and avoiding food triggers can all be helpful. Antihistamines can reduce the itch. Scratching is not helpful as it will trigger further inflammation and promote more itch.
Low dose topical steroid creams/ointments such as hydrocortisone 0.5-1% can be used sparingly on the face and in folds while higher dose prescription steroid products can be used on other areas of the body. Prescription products Elidel and Protopic are calcineurin inhibitors that can be used on the face (including eyelids) and all over the body. They suppress the immune response in the skin. The newest ointment is a prescription product called Eucrisa, which inhibits an enzyme called PDE-4, thereby reducing the production of inflammatory substances. It is not immunosuppressive like the calcineurin inhibitors and does not thin the skin as steroid creams can do over time. It can be used anywhere on the body including eyelids. This is a very exciting addition to our topical treatments. All creams and ointments mentioned are used twice daily and may require several weeks of regular application before the skin is completely clear. Some may cause a burning sensation which commonly goes away after a few days of use.
For severe atopic dermatitis there is a biologic therapy available that is given by injection. It blocks receptors on the outside of the cells that produce inflammatory chemicals. It is called Dupixent.
As cold weather approaches, be sure to moisturize heavily, use your humidifier and avoid extreme temperatures that can increase the risk of a flare.
Carolyn Whiskin is the Pharmacy Manager for Charlton Health. Carolyn specializes in the treatment of autoimmune diseases, pharmaceutical compounding, women’s health, pain and smoking cessation. Carolyn has won provincial and national awards for her commitment to patient care and public service.
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