Guidelines provide information on the management and treatment of this common skin condition.
Pharmacists can advise patients seeking advice on how to prevent and treat atopic dermatitis (AD), given the many topical, non-prescription products on the market, such as antihistamines, low-potency topical hydrocortisone products, moisturizers, and skin cleansers.
Self-management with a combination of OTC products and non-pharmacological measures is appropriate for most patients with mild to moderate AD. However, encourage patients who show severe or worsening signs of AD to seek further medical evaluation and treatment.
The American Academy of Dermatology (AAD) indicates that AD is a chronic, itchy inflammatory dermatological condition that is most common in pediatric patients, but also affects many adults.1 AD is commonly seen in patients with a personal or family history of allergic rhinitis and asthma.1
AD is the most common form of eczema, affecting more than 9.6 million pediatric patients and an estimated 16.5 million adults in the United States, according to the National Eczema Association (NEA).2
Its pathogenesis is often multifaceted and may involve environmental factors, epidermal and immunological barrier dysfunction, and a genetic predisposition.3-5 An estimated 50% of patients are diagnosed within the first year of life and up to 85% show symptoms before the age of 5 years.4
Patients with AD often experience flare-ups that can worsen their condition. Common triggers include dry skin, exposure to environmental or food allergens, exposure to extreme temperatures, skin irritants, and stress.6
More than 85% of those with AD experience itching on a daily basis, which can also cause pain and difficulty sleeping, according to the NEA.2
Clinical studies, recent news
Researchers sought to compare the clinical effectiveness and safety of the 4 primary emollient types used for childhood eczema, namely creams, gels, lotions, and ointments. The study involved 550 participants, ages 6 months to 12 years. Subjects were randomly assigned to use 1 of 4 types of emollients, and parents reported their observations weekly for 16 weeks and followed up every 4 weeks for 52 weeks.
Findings published in The Lancet Child and Adolescent Health indicated that there was no difference in efficacy and safety between the 4 primary types of emollients commonly used in pediatric eczema. The authors also noted that the overall number of side effects did not vary significantly between treatment groups, although stings were less common with ointments than with creams, gels or lotions.7
Findings published in The Journal of Allergy and Clinical Immunology: In Practice indicated that while a history of food allergies is common in pediatric patients with AD, only a small percentage of subjects in the study had food-induced AD (FTAD). FTAD, defined by physician-assessed sustained improvement in AD after food removal, was uncommon and occurred in only 3% of the total cohort and 2% of patients with mild AD, 6% of those with moderate AD and 4% with severe AD.8
Study findings published in the Journal of the American Academy of Dermatology indicate that individuals with AD showed a small but increased risk of incident dementia compared to the general population, and AD severity was correlated with greater risk. The study included individuals aged 60 to 99 years. In the adjusted Cox proportional risk models, patients with AD showed a 27% increased risk of dementia, and the incidence of dementia was 57 per 10,000 person-years among those with AD at follow-up, compared with 44 per 10,000 person-years in the the control group.
The researchers also noted that the correlation persisted even after adjusting for systemic corticosteroid use and potential mediators, and severe eczema was associated with a greater risk of dementia.9
Living with AD
Establishing a routine skin care regimen is critical to maintaining healthy, hydrated skin, and taking preventive measures can help prevent or reduce flare-ups.
The AAD and NEA provide several tips that patients can use to manage and prevent AD symptoms. These include the following:2.10:
- Bathe daily and take a 5 to 10 minute bath or shower in lukewarm, but never hot, water.
- Identify triggers for AD flare-ups and avoid them where possible.
- Eat healthy, manage stress and get enough sleep.
- Moisturize after bathing and when skin feels dry.
- Protect the skin from extreme temperatures.
- Seek help from a dermatologist if symptoms do not improve or worsen.
- Choose fragrance-free skin care products.
- Test all skin care products before using them.
- Before wearing, wash new clothes in detergent that is colorless and fragrance-free.
- Wear loose-fitting 100% cotton clothing, as cotton is less irritating and allows the skin to breathe.
More information can be found on the AAD website (https://www.aad.org/public/diseases/eczema/atopic-dermatitis-coping).
The NEA also has a handy application called EczemaWise to track symptoms and triggers (https://nationaleczema.org/turn-your-whys-into-wise-with-eczemawise/).
To effectively advise patients, pharmacists should be familiar with the guidelines for the treatment and management of AD published by the AAD in early 2022 (https://www.aad.org/member/clinical-quality/guidelines/atopic-dermatitis ).
Pharmacists can educate patients about the best OTC products for AD and the importance of using OTC skin care products that contain ceramides, which can be beneficial in maintaining, protecting and restoring natural skin barrier function and overall dermatological health. Pharmacists can also refer patients to the NEA website for a list of skin care products for AD that have been awarded the NEA seal of approval (https://nationaleczema.org/eczema-products/about-nea-seal-of-acceptance/).
About the author
Yvette C. Terrie, BSPharm, RPh, is a consulting pharmacist and medical writer in Haymarket, Virginia.
1. Davis DMR, Drucker AM, Alikhan A, et al. Guidelines of the American Academy of Dermatology: awareness of co-morbidities associated with atopic dermatitis in adults. J Am Acad Dermatoll. 2022;86(6):1335-1336.e18. doi:10.1016/j.jaad.2022.01.009
2. Atopic dermatitis. National Eczema Association. 2022. Accessed June 28, 2022. https://nationaleczema.org/eczema/types-of-eczema/atopic-dermatitis/
3. Kim BE, Leung DYM. Significance of skin barrier dysfunction in atopic dermatitis. Allergy Asthma Immunol Res. 2018;10(3):207-215. doi: 10.4168/aair.2018.10.3.207
4. BennerKW. Atopic dermatitis and dry skin. In: Krinsky DL, Ferreri SP, Hemstreet BA, Hume AL, Rollins CJ, Tietze KJ[NL1] red. Handbook of nonprescription drugs: an interactive approach to self-care. 20th ed. American Pharmacists Association; 2021:689-699.
5. Kim J, Kim BE, Leung DYM. Pathophysiology of atopic dermatitis: clinical implications. Allergy Asthma Proc. 2019;40(2):84-92. doi:10.2500/ap.2019.40.4202
6. Eczema Causes and Triggers. National Eczema Association. Accessed June 28, 2022. https://nationaleczema.org/eczema/causes-and-triggers-of-eczema/
7. Ridd MJ, Santer M, MacNeill SJ, et al. Effectiveness and safety of lotion, cream, gel and ointment emollients for eczema in children: a pragmatic, randomized phase 4 superiority study. Lancet Child Adolescent Health. 2022;6(8):522-532[NL2] . doi:10.1016/S2352-4642(22)00146-8
8. Li JC, Arkin LM, Makhija MM, Singh AM. Prevalence of the diagnosis of food allergy in pediatric patients with atopic dermatitis referred to allergy and/or dermatological subspecialty clinics. J Allergy Clin Immunol Pract. 2022; S2213-2198(22)00577-3. doi:10.1016/j.jaip.2022.05.028
9. Magyari A, Ye M, Margolis DJ, et al. Atopic eczema in adults and the risk of dementia: a population-based cohort study. J Am Acad Dermatoll. 2022;87(2):314-322. doi:10.1016/j.jaad.2022.03.049
10. Eczema Types: Atopic Dermatitis: Tips for Dealing With It. American Academy of Dermatology. Retrieved June 28, 2022. https://www.aad.org/public/diseases/eczema/atopic-dermatitis-coping