Atopic Dermatitis (Eczema)

What Is Eczema?

Eczema is a term used to describe skin conditions that involve skin redness, swelling, scaling, oozing/weeping, and/or dryness. The most common form of eczema is atopic dermatitis, sometimes called atopic eczema. This is what most patients and doctors are referring to when using the term “eczema”.

What Is Atopic Dermatitis?

Atopic dermatitis is a chronic inflammatory skin condition that affects more than 200 million people worldwide, including up to 20% of children and 10% of adults. While atopic dermatitis is more common in children (and often continues into adulthood), approximately 1 in 4 individuals with atopic dermatitis have adult-onset disease.

Different factors involved in the development of atopic dermatitis include a weakened skin barrier, increased activity of immune cells in the skin, and the community of microorganisms (microbiome) living on the skin. Some external environmental factors, such as living in urban areas or low-humidity regions, may increase the risk of atopic dermatitis.

What Are Common Symptoms of Atopic Dermatitis?

Atopic dermatitis often affects certain areas of the body, such as skin folds, head, face and neck, hands and wrists, and feet and ankles. Itch is the most common symptom associated with atopic dermatitis, but patients may also experience skin pain and sleep difficulties.

What Other Medical Conditions Are Associated with Atopic Dermatitis?

Many individuals with atopic dermatitis have a history of asthma, and/or environmental allergies. Atopic dermatitis is also associated with inflammation of the nose and sinuses, food allergies, mental health disorders (such as anxiety, depression, and attention deficit hyperactivity disorder), and infections such as impetigo or herpes.

What Are Other Potential Consequences of Atopic Dermatitis?

Atopic dermatitis can decrease quality of life, reduce productivity at work and school, and increase healthcare costs (hospitalizations, emergency visits, outpatient visits, and medications). Triggers for flare-ups vary among individuals and may include physical or emotional stress, changes in temperature or humidity, sweating, allergens, and irritants.

Which Non-Medication Treatments Can Help Manage Atopic Dermatitis?

Patients with atopic dermatitis should receive education about how to identify and limit exposure to triggers. They should also be encouraged to bathe daily, use soap-free cleansers, and apply fragrance-free and irritant-free moisturizer directly after bathing.

Which Medications are Available to Treat Atopic Dermatitis?

Although there is no cure for atopic dermatitis, medications that regulate inflammation and immune system activity can improve or resolve symptoms that are not well controlled with the non-medication treatments listed above.

For mild or moderate atopic dermatitis, first-line treatment is topical anti-inflammatory ointments and creams, including topical corticosteroids, which are available in a wide range of potencies. Other topical medications include calcineurin inhibitors (tacrolimus and pimecrolimus for patients aged ≥2 years), a topical phosophodiesterase-4 inhibitor (crisaborole ointment for patients aged ≥3 months), and topical Janus kinase inhibitors (ruxolitinib cream for patients aged ≥12 years).

For patients with moderate to severe atopic dermatitis, or for those who do not improve with topical medications, treatment options may include biologic therapy which is injected into the skin (dupilumab and tralokinumab for patients aged ≥6 months and 18 years, respectively), oral Janus kinase inhibitors (upadacitinib and abrocitinib for patients ages ≥12 and 18, respectively), phototherapy (commonly narrowband UVB light treatment), and oral immunomodulators (including methotrexate, mycophenolate, and azathioprine). Use of multiple agents may be required for long-term control of more severe presentations. Selection of treatment requires careful consideration of the risks and benefits of these therapies, and ongoing lab monitoring may be required for some of these medications.

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