Published: September 17, 2024
Atopic dermatitis, a type of eczema, is a common chronic inflammatory skin condition that requires ongoing management. Treating atopic dermatitis requires a long-term care approach. Atopic dermatitis is often associated with intense pruritus, but also can be complicated by pain and secondary infection without proper treatment and intervention.
“Primary care providers must communicate to parents that atopic dermatitis is not curable but can be properly managed over time,” said Patricia S. Todd, M.D., pediatric dermatologist with Norton Children’s Dermatology, affiliated with the UofL School of Medicine. “Expectation-setting with parents from the outset of a diagnosis can help them better understand their child’s condition and improve adherence to a treatment plan.”
To refer a patient to Norton Children’s Dermatology, visit NortonEpicCareLink.com and open an order for pediatric dermatology.
Refer online (peds)
Call (502) 559-7337 (PEDS) or (833) 559-7337.
Medication treatment strategies Short-term treatments, such as a one- or two-week course of topical steroids, may alleviate severe symptoms temporarily, but they are not a permanent solution. As a chronic condition, it can fluctuate over time, requiring different approaches based on the severity of symptoms.
When prescribing treatment, clarity is key. Misunderstandings about medication use are common and can lead to ineffective management of the condition or unwanted side effects. Provide detailed instructions for both flare and maintenance phases. Specify which medication to use, the exact dosage, the specific duration and the application areas.
For instance, instructing parents to “use triamcinolone 0.025% ointment for seven days on the rash on the arms” provides clear, actionable steps. Also, explaining what each medication is and its purpose (e.g., “Triamcinolone is a topical steroid, and mupirocin is a topical antibiotic.”) can further aid understanding and adherence.
Regular follow-ups can ensure the treatment plan is being followed correctly and facilitate any necessary adjustments based on symptoms. These check-ins can help clarify instructions, address confusion, reinforce the treatment plan and strengthen the patient-provider relationship.
Explore nonsteroid treatment options As an alternative to topical steroids, there are several nonsteroidal options available to help with predominantly mild to moderate cases. These include calcineurin inhibitors (e.g., pimecrolimus, tacrolimus), phosphodiesterase 4 inhibitors (e.g., crisaborole) and Janus kinase inhibitors (e.g., ruxolitinib for patients ages 12 and older). Offering these alternatives can help reduce the dependency on topical steroids and, in some cases, provide more long-term management options for patients.
In addition to any medications, it is essential that patients follow a dry skincare routine to manage atopic dermatitis. This routine helps restore barrier function of the skin, a key pathophysiologic mechanism of the disease. Encourage daily or every-other-day bathing with lukewarm water for no more than 10 minutes to hydrate the skin without causing irritation. Soap should be used sparingly and only on areas that truly need it, such as the armpits, groin and feet. Nonsoap cleansers are preferable, as they have less impact on the skin’s pH and are less likely to exacerbate symptoms.
Emollients should be applied immediately after bathing, to lock in moisture. The best moisturizing emollients are those that are thick: they usually come in jars, such as petroleum jelly, which is a highly effective, safe and affordable product. Added ingredients, such as fragrance, should be avoided.
Topical corticosteroids are a key component of managing atopic dermatitis and other forms of eczema. In recent years, there has been an increase in hesitancy surrounding these medications and their potential side effects. Common misconceptions about topical steroids include:
While topical steroids can cause hypopigmentation, it is rare and typically occurs only with significant overuse of higher-potency steroids. In most cases, lighter spots on the skin are a result of the eczema itself and are usually reversible.
Risk of topical steroid addiction or topical steroid withdrawal is low if the medications are used as prescribed. It is important to educate and provide detailed instructions about the correct application, dosage, potency and duration of use.
Guidelines for safe topical steroid use
To ensure safe and effective use of topical corticosteroids in patients with atopic dermatitis, primary care providers should follow these guidelines:
Side effects of topical steroids to recognize are skin atrophy and ocular toxicity.
Skin atrophy involves thinning and translucency of the skin, caused by steroids that are applied continuously, even after symptoms have improved. Atrophy is more likely to occur in areas with thinner skin, such as the face, neck, groin and armpits. Ocular toxicity can occur when topical steroids are applied around the eyes, increasing the risk for cataracts and glaucoma with prolonged use.
To help avoid topical steroid side effects, consider the following management strategies:
Most cases of atopic dermatitis can be managed effectively in a primary care setting. Patients with more severe cases or families who exhibit hesitancy or resistance to treatment options should be referred to Norton Children’s Dermatology.