There is no standard therapy for all patients with atopic dermatitis. Each patient must be treated individually.
Therefore, there is also not only one possible therapy for atopic dermatitis. The treatment consists of 5 elements:
- Avoidance of triggers
- Skin care
- Treatment of itching
- Treatment of inflammation
- Trainings and rehabilitation
Avoidance of atopic dermatitis-triggers
First of all it is essential to know what triggers the atopic dermatitis episode. This can be dust mites, animal hair, detergents or cleaning agents, food, etc… Also the weather can play a role.
A corresponding test can be made at the dermatologist or in appropriate laboratories.
A consistent avoidance of the trigger is the fundament for the treatment of eczema.
Skin requires daily care with moisturizing and refatting ointments or lotions that are natural and free of preservatives.
PH neutral products are preferable for cleansing the skin.
Many conventional bath additives or shower gels rob the skin of its protective barrier. These are therefore better avoided. The same applies to liquid soaps and surfactants. Salt as a bath additive can help bind the water in the skin and make it more supple. Especially helpful are refatting shower gels and bath oils.
After showering or bathing, the skin should not be rubbed dry. Just lightly dry or dab it dry. Immediately after showering or bathing, apply the moisturizing care product that you have received from your doctor or pharmacist for daily use.
Treatment of itching
Itching is excruciating in atopic dermatitis. The more it is scratched, the more inflammation occurs. This is a vicious cycle.
Only consistent trigger avoidance, skin care and adherence to the doctor’s treatment recommendations will improve the itching.
Keep children’s nails as short as possible to avoid injury. In an emergency, you can also put on gloves to the child.
Helpful also is wet wrap therapy
After doing a soak-and-seal warm bath and applying medication, the patient’s eczema-damaged skin is wrapped in a layer of wet cloths, topped often by dry clothes – such as pajamas, sweatshirt or tube socks.
Treatment of the inflammation
The inflammations are generally treated by skin ointments and by systemic medications.
Treatment of the skin
Mild to moderate inflammations are usually treated with anti-inflammatory cortisone ointments. Cortisone has an anti-inflammatory effect and is used primarily for acute episodes. Because of its side effects, cortisone should only be used for short periods. In addition, preparations containing cortisone are not suitable for all skin areas (e.g. face, genital area). Therefore, calcineurin inhibitors should rather be used in these areas. These creams also have an anti-inflammatory effect.
Besides cortisone ointments, the following products are also used for the treatment of atopic dermatitis.
Severe cases of atopic dermatitis are treated with systemic medications.
On the one hand, corticosteroids can be prescribed orally or as injections, and on the other hand, there are so-called biologic treatments, which are used as injection therapy.
Phototherapy is the treatment of the skin with electromagnetic rays mainly in the ultraviolet (UV) range.
UVA rays penetrate deeper into the skin and can therefore also combat deeper-lying inflammatory foci. High-dose UVA radiation therapy can be used for atopic eczema. Low-dose UVA radiation is used in PUVA therapy.
PUVA means that the effect of the UVA rays is intensified with the active drug ingredient Psoralen. Psoralen is administered to the patient by means of capsules, in the form of baths or ointments (if only individual areas of the body such as hands or feet are affected). The combination of Psoralen and UVA has proven to be very effective in many skin diseases, as this therapy exerts pronounced inflammation-suppressing effects.
In comparison, UVB therapy only penetrates the more superficial layers of the skin. This form of irradiation is comparable to natural sunlight. Pure UVB therapy is very easy to perform, has few side effects (can also be used on pregnant women, children or patients with a history of tumors) and is similarly effective as PUVA therapy for many skin diseases. In addition to suppressing inflammatory skin processes, all phototherapies also lead to a tanning of the skin.
Trainings and rehabilitation
In training courses for atopic dermatitis, patients learn how to deal with the disease in everyday life and at work. Information and practical tips for proper skin care, nutrition, dealing with relapses or relaxation techniques are offered.
Rehabilitation may be considered for severe eczema and a course of the disease with hardly any symptom-free periods. The aim here is to improve the treatment so that it is possible to continue working.
Often the eczema and itching lead to sleep problems, which can also put psychological strain on the patient. Relaxation exercises often help here. If the psychological complaints are pronounced, psychological therapy may also be an option.