How to Properly Treat Atopic Dermatitis and What to Do to Prevent Flare-Ups

Atopic dermatitis is a chronic inflammatory skin disease characterized by a violation of the skin barrier, increased sensitivity of the skin's immune system and its reactivity to various factors.

About how to properly treat atopic dermatitis and what to do to prevent an exacerbation, the portal "Healthy People" asked the dermatovenerologist of the City Clinical Skin and Venereological Dispensary of Minsk Svetlana Yakubovskaya and the head of the allergology department of the Children's City Clinical Hospital No 4 of Minsk, the chief freelance pediatric allergist of the Ministry of Health, Candidate of Medical Sciences Dmitry Buza.

Walking in circles

There are many factors that provoke the development of atopic dermatitis. By and large, anything can act as a trigger:

• climate (excessive dryness or excessive humidity, air temperature, weather conditions);
• environmental factors (air pollution with exhaust gases, dust, industrial waste);
• stress and nervous experiences;
• tobacco smoke;
• the presence of aggressive chemicals in household chemicals, cosmetics, hair and body care products (washing powders, fabric softeners, cleaning products, shampoos, shower gels, soaps, deodorants, etc.);
• clothing made of synthetic and artificial materials;
• excessive sweating;
• hormonal imbalance;
• allergy.

Svetlana Yakubovskaya: “The first step in treating atopic dermatitis is to identify the triggering factors in order to properly adjust the patient’s lifestyle and then provide appropriate skin care. This plays an extremely important role in comprehensive therapy. After all, if a patient with atopic dermatitis—to put it simply—continues to live under constant stress, spends most of their time indoors where the air is excessively dry or in places where people smoke, then no medication will help them. It will be like going in circles.”

Treatment Algorithm

Along with maintaining a healthy lifestyle, proper skin care is the foundation of treatment for atopic dermatitis.

Dmitry Buza: “There is no specific medication or cure-all for atopic dermatitis. That’s why proper skin care is so important. Emollients are used as first-line therapy. These are special skincare products designed for dry and sensitive skin. On the one hand, they deeply moisturize the skin, thereby protecting it from external irritants. On the other hand, they prevent rapid moisture loss from the skin itself. The rule for using emollients is: use as much as needed. This applies to both the amount and the frequency of application.”

Svetlana Yakubovskaya: “Emollients contain lipids, triglycerides, ceramides, and other substances that are essential for restoring the skin barrier. There are thicker, oilier products that are suitable for use as maintenance treatments during remission. And there are those with a lighter texture, which are best during flare-ups. So when choosing emollients, it’s important to consult with your doctor and follow their recommendations.”

Using moisturizers correctly is the key to success. Apply emollients within three minutes after showering (or personal hygiene routines) to damp skin in a thick layer, up to several times a day. As a guideline, you can use the approximate amount of emollient needed. For a young child with atopic dermatitis, this should be 250 ml per week; for adolescents and adults, 500 ml per week.

Svetlana Yakubovskaya: “You do end up using a lot of emollients. But they only work when used this way. And, unfortunately, there’s no alternative to them. No mass-market moisturizer can compare to specialized skincare products, since they lack the key ingredients needed to help restore the skin’s lipid barrier.”

If emollients alone do not resolve the problem, it is appropriate to prescribe topical hormonal medications (creams, emulsions, sprays, ointments). The choice of medication depends on the location of the skin lesions, their size, the nature of the condition (dry, itchy skin or weeping lesions), etc. A doctor should select the appropriate medication and determine the treatment regimen.

Svetlana Yakubovskaya: “During a flare-up, a combination of topical hormonal medications and emollients is used. In other words, the first step is to reduce inflammation, and then to restore the damaged skin barrier and prevent another flare-up. This usually takes 2–3 weeks. It’s important to see this period through and strictly follow the treatment regimen prescribed by your doctor. Otherwise, there’s a high risk that the inflammatory process will flare up again. During periods of complete remission, when there are no rashes, emollients should be used as maintenance therapy at least once a day.”

Non-steroidal agents with anti-inflammatory and immunosuppressive effects—calcineurin inhibitors—are also effective in the treatment of atopic dermatitis; the use of which carries a lower risk of potential side effects compared to topical corticosteroids. In cases of severe, persistent disease, cytostatic drugs may be recommended.

Phototherapy (narrowband phototherapy) is also considered one of the proven treatments for atopic dermatitis. Phototherapy is based on the effect of ultraviolet rays of a specific wavelength on the skin’s immune mechanisms.

Don’t forget about another way to combat a flare-up: moist wraps. They effectively relieve itching and allow the nourishing ingredients from the emollients applied beforehand to penetrate deeper into the skin.

Dmitry Buza: “Another issue related to atopic dermatitis that is important to mention is, — Skin infection. A mother immediately treats any scratch or cut on her child’s body with hydrogen peroxide or green antiseptic to prevent infection. But when that same child, say, scratches skin affected by atopic dermatitis, hardly anyone is concerned about preventing infection. I can say that when children with a flare-up of atopic dermatitis come to us, we often begin treatment—strange as it may seem—with antibiotics. This is because the infection that has taken hold on the skin as a result of scratching and trauma sustains and exacerbates the inflammatory process. Staphylococcus aureus is the most commonly isolated pathogen in severe cases of atopic dermatitis. — in nearly 100% of children. The second most common — a fungal infection. Therefore, preventing skin infections — "This includes, among other things, preventing flare-ups and the progression of atopic dermatitis."

Lifestyle Management for Atopic Dermatitis. Preventing Flare-Ups

To properly manage daily life in a family that includes a person with atopic dermatitis, it is necessary to:

• If an allergic component of atopic dermatitis is confirmed, completely avoid contact with the allergen.
• Monitor the humidity level in your apartment. The ideal range is 40–60%. Remember that both dry and excessively humid air can negatively affect the course of atopic dermatitis;
• Ventilate the room frequently;
• Avoid using harsh detergents and household chemicals. In particular, it’s wiser to replace laundry detergents with laundry gels. Unlike powders, they rinse out completely and do not leave microparticles on clothing that can irritate the skin. It’s best to avoid fabric softeners altogether or choose hypoallergenic ones that are fragrance-free;
• When using personal care products, choose mild shampoos, soaps, and shower gels that are free of parabens, dyes, artificial fragrances, etc.;
• Install water softening filters whenever possible;
• When choosing clothing, give preference to natural fabrics with a low (up to 20%) content of synthetic fibers;
• avoid excessive sweating;
• Clean with a damp cloth regularly to prevent dust from accumulating. If there is mold in the apartment, it must be removed immediately;