Atopic dermatitis (AD) is the most common form of eczema. It makes your skin itch and form a dry, crusty rash. There's no cure for AD, but you can control it with the right treatment.
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How Your Doctor Creates Your Treatment Plan
To figure out what will work best for your symptoms, your doctor will first look carefully at your skin and discuss your medical history. They might ask:
- Does anyone else in your family have AD?
- Have you had treatment for AD before?
- How often are you bothered by itching?
- Have you noticed any triggers that make it worse?
- What other medical conditions do you have?
They'll also want to know where symptoms show up on your body. Most commonly, AD appears on:
Infants can also sometimes have it on their face and scalp.
Usually, your answers to these questions give your doctor enough to go on to plan your treatment. If they need more information, they can do tests such as:
- An allergy skin test
- Blood tests to help rule out other causes of the rash
- A skin biopsy
Based on what they see, your doctor will decide if your AD is mild, moderate, or severe.
How Serious Is Your Atopic Dermatitis?
Mild
- Some areas of dry skin
- Itching some of the time
- Some redness
- Your daily life isn't affected much
Moderate
- Some areas of dry skin
- You itch often
- Your AD patches are red
- Your AD affects some areas of your daily life
Severe
- Dry skin on lots of your body
- Constant itching
- Red, thickened skin that oozes, bleeds, and cracks
- Your life is limited by your AD (for example, you lose sleep because of it)
A typical treatment plan includes a combination of:
- Skin care to protect your skin barrier
- Trigger management
- Medication or other therapies
- Self-care such as getting enough sleep, eating healthy foods, and managing stress
The goals of treatment are to reduce inflammation, heal the skin barrier, and improve quality of life.
Your skin is your shield against elements such as germs, chemicals, and allergens. AD and some of its treatments can make your skin weaker and less able to protect you against the outside world. One way to treat AD symptoms is by strengthening your skin barrier.
Your race plays a part in the thickness and hydration level of your skin. People of color can have drier skin and lose water more quickly from their skin barrier. This might affect what type of medication and moisturizers your doctor recommends.
Moisturizing treatments you rub on your skin to trap water in and cover it with a protective film are called emollients. The more oil an emollient has, the better it usually is for treating AD.
Ointments such as petroleum jelly have the most oil and feel greasiest but are best at sealing in moisture.
Creams have less oil than ointments but still work well to trap water in your skin. Choose one without preservatives or other ingredients that could irritate your skin.
Lotions are mostly water with only a little oil. They evaporate quickly and can sometimes burn broken skin.
Prescription skin barrier creams have lipids (fats) and ceramides like the ones found naturally in healthy skin barriers. They go only on parts of your skin with AD, where they help form a protective layer.
Just as important as the emollient you pick is the way you apply it. For best results:
- Use it at least twice a day.
- Put it on after every bath or shower. (Pat your skin dry first.)
- Apply it gently and in the direction your hair grows.
- Take it with you on the go.
- Keep using it even after flare-ups die down.
Unlike ordinary moisturizers, emollients for AD don't have scent or extra ingredients.
The way you bathe can have a big impact on your skin hydration and strength. For best symptom control and a stronger skin barrier:
- Limit your amount of time in the water to 10-15 minutes.
- Keep the water warm instead of hot.
- Don't scrub your skin.
- Use mild soaps free of perfumes or dyes.
- Pat your skin dry instead of rubbing it.
- Apply an emollient right after drying.
Medications
If moisturizing and other self-care don't take care of your AD symptoms, your doctor may suggest over-the-counter or prescription medications. Depending on how serious your symptoms are, they might recommend one or more treatments.
Topical corticosteroids
These come in prescription and over-the-counter form, and they're applied to your skin (topical). You use these when your symptoms flare up. They may have side effects, such as thinning of the skin, stretch marks, spider veins, irritation around the mouth, and acne or rosacea-like rashes.
Examples include:
- Hydrocortisone
- Triamcinolone
- Flurandrenolide
Topical calcineurin inhibitors (TCIs)
These creams or ointments reduce itch and swelling. They also get rid of excess bacteria on your skin that can cause symptoms. Your doctor may prescribe one if topical steroids stop working. Or they might ask you to use one along with a topical steroid.
TCIs have fewer side effects than topical steroids but can cause burning or stinging.
Examples include:
- Pimecrolimus (Elidel)
- Tacrolimus (Protopic)
Topical PDE4 inhibitors
Phosphodiesterase 4 (PDE4) is an enzyme in your body that makes inflammatory signals called cytokines. Topical PDE4 inhibitors block this enzyme. As a result, you have less inflammation, which soothes AD symptoms.
The only FDA-approved topical PDE4 inhibitor is crisaborole (Eucrisa).
Oral or injectable corticosteroids
Your doctor may prescribe steroids you take by mouth or by shot to control severe flares. You take these only for a short time. They suppress your immune system, so your risk of illness and infection goes up while you're on them. They can also make you gain weight.
The most common option is prednisolone.
Antihistamines
These drugs don't treat AD, but a doctor may suggest them for kids with AD when itching keeps them awake. They cause drowsiness.
Options include:
- Diphenhydramine (Benadryl)
- Cetirizine (Zyrtec)
- Fexofenadine (Allegra)
Systemic immunosuppressants
These drugs are used for moderate to severe AD. They turn down the immune response that causes inflammation and itching in your body. This helps stop the scratch-itch cycle so your skin can heal. Doctors consider them "off-label" since the FDA has not approved their use for AD.
Examples include:
- Azathioprine
- Cyclosporine
- Methotrexate
- Mycophenolate mofetil
Biologics
Biologics are medications made with proteins that come from living tissues or cells cultured in a laboratory. They treat your AD at the immune system level. They block chemical messengers that turn on the inflammatory response in your body. You take them through an IV or as a shot just under your skin.
These biologics are approved to treat moderate to severe atopic dermatitis:
- Dupilumab (Dupixent) for people ages 6 months and up
- Tralokinumab-ldrm (Adbry) for adults only
JAK inhibitors
These are the newest class of AD drugs. Many are still in development. They're topical creams. They work by closing off certain pathways in your body that increase your inflammatory response. This reduces itching.
These JAK inhibitors are approved to treat moderate to severe atopic dermatitis:
- Abrocitinib (Cibinqo) for adults
- Ruxolitinib (Opzelura) for people 12 years old and older
- Upadacintinib (Rinvoq) for people 12 years old and older
Other Therapies
Alongside your medication, your doctor may also recommend another therapy such as:
Light therapy
In this therapy, you're exposed to ultraviolet light from special lamps to reduce the inflammation of moderate to severe AD. You have this treatment 2-3 times a week for several weeks. Light therapy can cause skin redness and dryness. You may also see a flare in your AD right as you begin light therapy.
Wet wraps
For this therapy, fabric soaked in water is wrapped around the affected parts of your skin. Then a dry layer of fabric is added on top. A nurse might do this in a hospital, or your doctor can train you to do it yourself. During very itchy spells, wet wraps can rehydrate and soothe your skin. It's best to do them after bathing, moisturizing, and applying topical meds.
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Learn More About Atopic Dermatitis
How Does AD Affect Your Body?
Ways to Soothe Your Skin
Sleep Well When You Have AD