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Atopic dermatitis, sometimes referred to as atopic eczema, is a chronic inflammatory dermatologic disorder that is typified by scaly, erythematous, and pruritic skin lesions that are normally restricted to the body’s flexural surfaces. As part of the allergic triad, which also include asthma and allergic rhinitis. As a result, 30% of children with atopic dermatitis go on to acquire asthma in their later years. Only 10% of instances of atopic dermatitis are detected beyond the age of five, as it often manifests before the age of two. According to a research by Frazier and Bhardwaj (2020), which polled pediatric patients across the United States, the incidence among children was as high as 19% in some places and roughly 11% nationwide. Significant morbidity from sleep disturbances, chronic postinflammatory dermatological changes, scarring formation from scratching and picking, and the development of subsequent skin infections with such pathogens as herpes viruses, Streptococcus, and Staphylococcus, may be avoided with early diagnosis and treatment.
However, atopic dermatitis has no known cure, as much as there exist some medications that can be helpful in managing the symptoms. In actuality, an unparalleled quantity of novel atopic dermatitis treatments are presently under development. In many cases of atopic dermatitis, xerosis is present, and patients report that managing their dry skin is akin to managing their dermatitis. Therefore, whether or not they have active symptoms, people with atopic dermatitis ought to generously apply emollients to their whole body. According to a study by Frazier and Bhardwaj (2020), regular use of emollients decreased the necessity for using topical corticosteroid and help ensure improved symptoms in infants with moderate to severe atopic dermatitis.
Comparable to emollients, moisturizers aid in preserving and restoring skin moisture. All emollients are not created equal, though. Emollients with a high oil content and a low water content are often advised. Preferred are thick creams with minimal water content, such Cetaphil and Eucerin, or ointments, like Petroleum Jelly or Aquaphor (Puar et al., 2021). The latest batch of barrier-repair moisturizers has emerged, such Cerave and Restoraderm, that are intended to provide skin with ceramide lipids in addition to moisture, albeit their superiority over traditional emollients is not well established. Doctors should advise patients to take warm showers rather than hot ones and to use an emollient wash while doing so to prevent xerosis.
For flare-ups of atopic dermatitis, topical corticosteroids are the primary line of treatment. Group VII has the least potent medications, such as 1% hydrocortisone, and group I, which is the most potent and includes clobetasol (Temovate). Generally speaking, the potency ought to be adjusted according to the disease’s severity. Longer courses of higher-potency corticosteroids are frequently required for individuals with lichenified plaques indicative of chronic eczema (such as lichen simplex chronicus), and occlusive therapy may also be beneficial (Sroka-Tomaszewska & Trzeciak, 2021). Mild-potency corticosteroids are recommended for the axillary regions, groin, neck, face, and surfaces of flexor muscles in order to prevent atrophy. For short periods (two weeks or less), moderate potencies can be used in these areas if the patient is experiencing a significant flare-up.
Topical calcineurin inhibitors, which are immunomodulators and regarded as second-line therapy, include pimecrolimus (Elidel) and tacrolimus (Protopic). In patients with moderate to severe atopic dermatitis, they are typically only used temporarily or sporadically for long-term therapy. This is particularly the case when there is worry that continuous topical corticosteroid administration may have unfavorable side effects, like atrophy (Sroka-Tomaszewska & Trzeciak, 2021). These medicines are especially helpful for areas of thinner skin on the face, neck, and skin folds because they do not produce skin atrophy. Another advantage is that even after extended treatment, they do not exhibit tachyphylaxis, which is a reduction in reaction to a medication when it is taken frequently.