How is atopic dermatitis treated?
Treatment of atopic dermatitis should be tailored to the patient based on their age, extent and severity of disease, stage of disease (acute or chronic), location of the lesions, and the patients’ preferences, with the aim to improve quality of life.
Atopic dermatitis is a chronic, incurable but treatable skin disease associated with intense itch, skin pain, sleep disturbances, and psychological conditions such as depression and anxiety. There are many triggering factors for atopic dermatitis, including stress, irritants, allergens, infections, and changes in weather or season. These triggers can cause acute flares and have a significant impact on a person’s quality of life. Flares are an integral part of the disease trajectory, and based on the level of disease severity, treatment may be adjusted, modified, or intensified, as well as making lifestyle changes. Therefore, management approaches to atopic dermatitis should address both the periods of acute worsening and the chronic nature of the disease.
Management strategies for treating atopic dermatitis follow a stepped-care approach and include the use of emollients, topical treatments, phototherapy and/or systemic treatments. In children with atopic dermatitis, it is also important that the caregivers receive adequate knowledge, skills, resources, and support to manage the treatment of their child at home and cope with the impact on family life.
Care for people with atopic dermatitis must go beyond the treatment of skin lesions and include addressing comorbidities, such as allergic rhinitis and asthma. Food allergies, allergic and irritant contact dermatitis, decreased bone health and autoimmune diseases are more frequently reported in people with atopic dermatitis, and these associated health conditions need to be taken into account. Health care providers should therefore treat people with atopic dermatitis as a whole person, and not just focus on the skin. This also extends to considering the burden of the skin disease on carers, and the impact on family life. Preferably, when treating atopic dermatitis, the principle of shared decision-making should be applied, which means that the patients’ beliefs, lifestyle, and preferences are discussed when deciding on a treatment plan.
People with atopic dermatitis are more likely to develop mental health conditions such as anxiety and depression, have an increased rate of suicidal ideation and report more difficulties facing life. Psychological and educational interventions should be implemented to positively influence disease progression and improve overall psychological wellbeing.
Treatment recommendations for atopic dermatitis follow a stepped-care approach depending on severity, as shown in the figure below. These treatment recommendations can be adapted for countries based on local needs, availability of medication, potential benefits and harms, access to healthcare, costs, limitations, and advantages and inconveniences of the suggested therapeutic options.