Atopic dermatitis is a common genetically determined chronic inflammatory disorder of the skin. Eczema is a term used to describe the appearance of the skin in atopic dermatitis, as well as in other skin diseases. Though atopic dermatitis generally tends to be more severe in childhood and improve in adulthood, most people with this condition continue to have remissions and exacerbations throughout their lifetimes.
Environmental factors such as weather changes and food allergies can exacerbate the eczema and itching. Atopic dermatitis is usually more bothersome during the winter months due to excessive dryness. Individuals with atopic dermatitis are more likely to have sensitivities to foods and exposure to these foods can worsen their eczema. Individuals with eczema tend to be most sensitive to the following foods: milk, wheat, soy, peanut, egg, and seafood.
Though there is no known cure for atopic dermatitis, many treatments are available to relieve the symptoms and improve one’s quality of life.
Traditionally, management of atopic dermatitis consists of:
- Identifying the triggering and aggravating factors (which can vary from patient to patient) for eczema and avoiding exposure as best as possible.
- Hydrating the skin with daily application of emollients (i.e., moisturizing creams and lotions) all over the body immediately after bathing or showering.
- Limiting the duration of bathing or showering to a few minutes, if possible.
- Oral antihistamines to relieve the troublesome itching. The goal is to break the itch-scratch cycle which can perpetuate eczema.
- Antibiotics to reduce the colonization of the inflamed skin with bacteria, especially when there are open sores in order to prevent secondary skin infections such as staph.
- Topical calcineurin inhibitors [e.g., Protopic (tacrolimus) ointment and Elidel (pimecrolimus) ointment] are immunomodulators which can help in controlling inflammation of the skin. Note that this group of drugs carries an FDA “black box” warning that certain type of tumors (e.g., lymphomas) were observed in rodents receiving these medications.
- Corticosteroid creams and ointments are the mainstay of controlling the flare-ups of eczema due to their anti-inflammatory properties. More than a dozen varieties of topical steroids are available with varying degrees of potency. Due to their potential side effects which can include thinning of the skin and whitish discoloration (i.e., hypopigmentation), among their use is generally restricted to 10 days to 2 weeks at a time.
- In severe cases of atopic dermatitis unresponsive to the usual treatments, systemic immuno-suppressants (e.g., cyclosporine, dapsone) are employed to control severe inflammation. However their use is limited by their toxicity to other organs such as the liver and kidneys.
Very recently, two new forms of treatments for atopic dermatitis were approved by FDA.
- Eucrisa (i.e., crisaborole) belongs to a class of drugs called phosphodiesterase-4 (PDE-4) inhibitors. It is available as a 2% ointment and indicated for treatment of mild to moderate atopic dermatitis in patients 2 years of age and older. It should be applied in a thin layer to the affected area twice a day. Since it is not a steroid, it can be applied even to the face.
- Dupixent (i.e., dupilumab) is a biologic injectable medication approved for treatment of moderate to severe atopic dermatitis not adequately controlled by topical therapies in patients 18 years of age and above. It is a monoclonal antibody which blocks the receptor of a common inflammatory mediator called IL-4 (i.e., interleukin-4). The initial dose is two injections (given subcutaneously under the skin) of 300 mg. each at different sites, followed by 300 mg. every other week. It can be used along with or without topical steroids preparations.
Black & Kletz Allergy has board certified allergy and immunology specialists as well as a trained staff experienced in both the diagnosis and treatment of atopic dermatitis of varying degrees of severity. We treat both children and adults and have 3 convenient office locations in the Washington, DC, Northern Virginia, and Maryland metropolitan area. Black & Kletz Allergy has offices in Washington, DC, McLean, VA (Tysons Corner, VA), and Manassas, VA. We have on-site parking at each location and the Washington, DC and McLean offices are Metro accessible. There is a free shuttle that runs between the McLean, VA office and the Spring Hill metro station on the silver line. Please call us if you, a family member, a friend, or a colleague suffers from eczema or atopic dermatitis and want to be evaluated and treated. In addition to conventional therapy, we also have expertise in the newer treatment options for the treatment of eczematous dermatitis or any other allergic or immunologic disorder. You may also click Request an Appointment and we will respond within 24 hours of the next business day. The allergists at Black & Kletz Allergy strive to keep up with the newest allergy and asthma treatment modalities so that cutting edge medicine is always available to our greater Washington, DC community.