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Atopic Dermatitis Patient Management

After a diagnosis of atopic dermatitis (AD), also known as eczema, has been confirmed through detailed patient history, and clinical observation, long term management of your patient’s AD will depend largely on their personal manifestation of signs and symptoms. The primary goal of long term management is to reduce acute and worsening “flares” of symptoms.

You have a range of treatment and overall management options to choose from when crafting a personalized plan for your patient with AD. Topical agents are the mainstay of treatment when managing AD, however severe cases may require the use of immunosuppressive drugs in conjunction with phototherapy.1,2 Your approaches may range from daily moisturizing barrier cream, optimal skin hygiene, avoidance of allergic triggers, topical corticosteroids, and calcineurin inhibitors. You may also choose to combine these, depending on the frequency, severity, and location of your patient’s symptoms.1

To assist you in selecting the most appropriate treatments, consider consulting with these well-established clinical guidelines:

Educating Patients on the Management of AD Symptoms

Educating patients, their families, and caregivers is itself a vital form of intervention with atopic dermatitis. AD has a complex pathogenesis, so it is important that patients understand the disease and its course. With the possibility of multiple therapies needed to manage symptoms, setting appropriate treatment expectations and goals can yield significant results. Taking the time to provide sufficient education to patients may lessen fears and misconceptions, and may lead to better compliance and ultimately, better outcomes. 3,4

Teaching patients how to manage their eczema day to day may include:1

  • Eliminating aggravating factors and triggers, such as heat, perspiration, emotional stress, and exposure to certain chemicals, cigarette smoke, or cleaning solutions
  • Keeping skin hydrated with emollient creams and ointments
  • The use of oral antihistamines to help relieve itching

Specialist care may be recommended in patients who do not respond to primary measures taken against AD; as those with severe eczema may benefit from immunosuppressive drugs or the use of injectable medications.2

Monitoring, Reevaluation, and Further Testing

In one study, children with eczema had a 3-fold increased odds of developing asthma (adjusted odds ratio [aOR], 3.07; 95% confidence interval (CI) 1.79–5.27), and a nearly 3-fold increased odds of developing rhinitis.5 Additionally, patients with AD and specific IgE antibodies to common environmental allergens are at a significantly higher risk for progressing towards allergic rhinitis and asthma than those without specific IgE sensitization.6

Having severe eczema, early-onset eczema, and persistent eczema further increases the risks of developing asthma and rhinitis, and these risks should be monitored and accounted for with further testing at patient follow up appointments.5

To better optimize management, clinicians are recommended to identify patients with AD who may be at risk for other conditions, such as allergic rhinitis, sleep-disordered breathing, conjunctivitis, rhinosinusitis, and otitis media.7 Overlapping symptoms can be the first clue that multiple conditions are present. Identifying these sensitizations can help you create a plan that manages all of your patient’s symptoms and conditions.

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References

  1. Eichenfield L, Tom W, Berger T, et al. Guidelines of care for the management of atopic dermatitis: Section 2. Management and treatment of atopic dermatitis with topical therapies. J Am Acad Dermatol. 2014;71(1):116-132.

  2. Megna M, Napolitano M, Patruno C, et al. Systemic Treatment of Adult Atopic Dermatitis: A Review. Dermatol Ther (Heidelb). 2017;7(1):1-23.

  3. Smith SD, Hong E, Fearns S, et al. Corticosteroid phobia and other confounders in the treatment of childhood atopic dermatitis explored using parent focus groups. Australas J Dermatol. 2010;51: 168-174.

  4. Snyder, A, Farhangian M, Feldman SR. A Review of Patient Adherence to Topical Therapies for Treatment of Atopic Dermatitis. Cutis. 2015;96(6):397-401.

  5. Von Kobyletzki, Bornehag CG, Hasselgren M, et al. Eczema in early childhood is strongly associated with the development of asthma and rhinitis in a prospective cohort. J Am Acad Dermatol. 2014;71(1):116-132.

  6. Saunes M, Øien T, Dotterud CK, et al. Early eczema and the risk of childhood asthma: a prospective, population-based study. BMC Pediatr. 2012;12:168.

  7. Seidman MD, Gurgel RK, Lin SY, et al. Clinical practice guideline: allergic rhinitis executive summary. Otolaryngol Head Neck Surg. 2015;152(2):197-206.