DIAGNOSIS, TREATMENT, & STEPS TO TAKE

Diagnosis of Atopic Dermatitis

Diagnosing atopic dermatitis may include the following:

  • Giving the doctor your or your child’s medical history, including:
    • Your family history of allergies.
    • Whether you also have diseases such as hay fever, asthma, or food allergies.
    • Sleep problems.
    • Foods that seem to trigger hives.
    • Previous treatments for skin-related symptoms.
    • Use of steroids or other medications.
    • Exposure to irritants, such as:
      • Soaps and detergents.
      • Some perfumes and cosmetics.
      • Cigarette smoke.
  • Examining your skin and the rash.
  • Ordering laboratory tests, such as:
    • Blood tests to check for other causes of the rash.
    • Skin biopsy of the rash or lesion.

Your doctor may need to see you or your child several times to make an accurate diagnosis and to determine if symptoms are from other diseases and conditions or from atopic dermatitis.

Treatment of Atopic Dermatitis

The goals for treating atopic dermatitis include:

  • Manage and control dry skin.
  • Reduce skin inflammation.
  • Control itching.
  • Promote healing.
  • Prevent infections.
  • Prevent flares.

Your doctor will work with you to develop a treatment plan based on the:

  • Location and type of rash, including the severity of the itching.
  • Triggers that are unique to you or your child, to avoid exposure and prevent potential flares.
  • The skin’s response to specific treatments, to identify which treatments seem to work best.

Treatments usually include a combination of therapies and can include:

  • Medications. Your doctor may prescribe one or more of the following medications to treat atopic dermatitis, depending on the severity of the disease and your or your child’s age:
    • Moisturizing creams can help restore the skin barrier.
    • Corticosteroid creams and ointments help to decrease inflammation and are commonly used to treat diseases affecting the skin. Doctors do not usually prescribe oral corticosteroids to treat atopic dermatitis because after stopping the normal dose, atopic dermatitis can flare or rebound and be more severe than before.  
    • Calcineurin inhibitors applied to the skin decrease inflammation and help prevent flares.
    • Phosphodieterase-4 inhibitors, a topical cream, can help with inflammation when the symptoms do not respond to other treatments.
    • Pills that reduce the abnormal immune response can be used but are reserved for more severe disease, and they require close monitoring. These include janus kinase (JAK) inhibitors, which send messages to specific cells to stop inflammation from inside the cell.
    • Biologic medication, which is given by an injection just under the skin, blocks specific functions of the immune system to help control and manage atopic dermatitis. 
  • Skin care. Keeping the skin hydrated by applying moisturizers immediately after bathing to hold the water in your skin is important when treating atopic dermatitis. Your doctor will recommend how often you or your child should bathe and the type of moisturizer you should use. In some cases, doctors may recommend the following skin care for AD:
    • A diluted bleach bath twice a week to help treat AD. It is important to follow your doctor’s specific instructions when taking a bleach bath. You should not use this treatment without first talking to your doctor.
    • Wet wrap therapy to help increase moisture in the skin when the condition is persistent. However, only use wet wraps after speaking with your doctor.
  • Phototherapy. If the atopic dermatitis is severe, widespread, and has not responded to cream and ointment treatments, your doctor may recommend the use of ultraviolet A or B light waves to treat symptoms.

If you or your child develops skin infections from atopic dermatitis, your doctor may recommend additional topical or oral antibiotic treatments.

It is important to use skin treatments as directed and follow up with your doctor regularly to make sure the treatment plan is working.

Who Treats Atopic Dermatitis?

The following health care providers may diagnose and treat atopic dermatitis:

  • Dermatologists, who specialize in conditions of the skin, hair, and nails. You may want to find a dermatologist that specializes in treating atopic dermatitis.
  • Allergists, who specialize in treating allergies.
  • Primary health care providers, including family doctors, internists, or pediatricians. 

Living With Atopic Dermatitis

Depending on the location and severity of the atopic dermatitis, living with the condition can be hard. Here are some tips to help control atopic dermatitis.

  • Caring for skin. Following a daily skin care routine is important and helps prevent flares. Skin care can include:
    • Taking lukewarm baths to cleanse and moisturize the skin without drying it excessively. Limit baths to once a day.
    • Using mild unscented bar soap or non-soap cleanser.
    • Patting the skin dry after bathing and not allowing it to get too dry before moisturizing (avoid rubbing or brisk drying).
    • Using a moisturizer to seal in the water that has been absorbed into the skin during bathing. Use cream and ointments and avoid lotions with high water or alcohol content, which can cause burning.
    • Protecting the skin from irritants and rough clothing, such as wool.
  • Talking to your doctor about potential food allergies.
  • Managing stress. Using stress management and relaxation techniques can help lower your stress and decrease the likelihood of flares. Developing a network of support that includes family, friends, health professionals, and support groups or organizations can be beneficial.
  • Preventing skin irritations. Try to avoid scratching or rubbing, which irritates the skin, increases inflammation, and can increase itchiness. Keep your child’s fingernails short to help reduce scratching.
  • Seeking counseling. If you are feeling overwhelmed, embarrassed, or anxious about the condition, seek counseling with a mental health professional.
  • Maintaining level indoor temperatures. Try keeping the inside of your home at a cool, stable temperature and consistent humidity levels. Avoid situations where overheating may occur. This may help prevent flares.
  • Getting restful sleep. If you or your child is unable to get restful sleep at night because of itching and scratching, talk to your doctor about options to better control the atopic dermatitis.
  • Avoiding exposure to the smallpox vaccine. Anyone with atopic dermatitis should not receive a smallpox vaccine. If you have atopic dermatitis and you receive the smallpox vaccine, you are more likely to develop a serious complication to the vaccine, even if your condition is mild or not active at the time of the shot. In addition, you should avoid being around others who have recently received the vaccine. Talk to your doctor about your risks before anyone in your household receives the vaccine.  

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