Atopic Dermatitis (AD) is a type of Eczema and is most frequently associated with dry, itchy scaly skin. The National Eczema Association estimates that over 30,000,000 people suffer with Eczema in the United States. More than half (56%) of all Eczema patients have Atopic Dermatitis.
Atopic Dermatitis is frequently diagnosed in children as a chronic skin disorder that in many cases continues into adulthood. It results from an overactive immune response causing chronic inflammation that affects the skin. Symptoms may disappear for a period but, as there is no known cure, the disease is lurking under the skin and will frequently flare up after periods of inactivity. The exact cause of Atopic Dermatitis is unclear, but researchers believe it is more than 80% related to genetics and therefore is hereditary. Researchers have identified more than 40 genetic mutations in the filaggrin gene (FLG) in up to 50% of moderate to severer AD cases. People with one or more of these mutations are up to 3X more likely to develop Atopic Dermatitis. The primary characteristics of AD include:
- Dry, itchy, scaly skin
- Raw, sensitive, swollen skin from scratching
- Open, crusty, or weeping sores, especially during flare-ups
- Possible infection as witnessed by red streaking or yellow scabs
- May affect sleep and activity patterns
Symptoms, Diagnosis & Treatment
| Symptoms | Diagnosis | Treatment |
| Family history of AD | Pruritus, or itching | Medications |
| Dry skin | Eczema in addition to age related patterns and chronic recurrence | Phototherapy |
| Itching, often severe | In infants and young children: eczema on facial, neck, and outer surfaces of the limbs | Moisturizers |
| Red to brownish grey patches | In any age, current or previous eczema on inner surfaces of the joints, like the inner crease of the elbow or knee | Avoiding harsh soaps over the use of neutral or low pH, hypoallergenic, fragrant-free cleansers |
| Small, raised bumps, which may leak fluid and crust over when scratched | Supported by early age of onset, genetic predisposition to develop an allergy, immunoglobulin E (IgE) reactivity, and xerosis, or dry skin | Wet wrap therapy with or without topical medication to improve skin moisture, adsorption of medications, and to act as a physical barrier to itching |
| Thick, cracked, scaly skin | Associated symptoms that may help lead to a diagnosis but are not definitive of the condition include atypical vascular responses, keratosis pilaris – when the skin has tiny, hard bumps around hair follicles, pityriasis alba – dry, white patches, hyperlinear palms – extra creases in the palms of the hands, involvement of the skin around the eyes, involvement of the skin around the mouth or ears, involvement of the hair follicles in the skin, lichenification – thickened patches of skin, or prurigo lesions – itchy nodules with skin eruptions
|
Bleach bath therapy to control skin bacteria and minimize infection (refer to the American Academy of Dermatology for recommended recipe) |
| Comorbidity with asthma and hay fever is common | Maintain proper skin care and avoid rough, abrasive materials (e.g., towel gently after washing and apply moisturizers while skin is still wet) |
NOTE: NOT INTENDED AS MEDICAL ADVICE. DRUGS FOR THIS CONDITION MAY BE ASSOCIATED WITH UNWANTED SIDE EFFECTS OR ADVERSE REACTIONS. CONSULT YOUR PHYSICIAN BEFORE TAKING ANY DRUGS FOR THIS CONDITION.
Medications that may be prescribed by a doctor for AD include Corticosteroids of varying potency, non-steroidal chemical immunosuppressants, and Biologics. Immunosuppressants work by blocking one or more immune responses thereby providing relief of the condition. Your doctor may also prescribe antihistamines to control itching and antibiotics to control infection during a flare-up.
Corticosteroids have a multi-modal effect on the immune response by binding with the DNA of epidermal and dermal cells. Since Atopic Dermatitis is essentially caused by an overactive immune response, topical corticosteroids can significantly reduce symptoms during a flare-up. Other chemical immunosuppressants prescribed for AD include the non-steroidal, topical calcineurin inhibitors and the non-steroidal, topical PDE4 (phosphodiesterase-4) inhibitor. These drugs have the advantage of not thinning the skin like long-term use of topical corticosteroids can. But they have their own set of unwanted side effects.
Biologics are produced from living organisms or contain components of living organisms and are the most advanced therapies available. Unlike the chemical immunosuppressants, their exact structure may not be known but their mode of action is highly researched and tested. They are sometimes referred to as biologic response modifiers because they change the manner of operation of natural biologic intracellular and cellular actions. There is a considerable amount of research to identify biologics for long-term control of Atopic Dermatitis.
AD drugs that may be prescribed by your doctor include:
| Highly Potent Corticosteroids
(Topical) |
Moderately Potent Corticosteroids
(Topical) |
Mildly Potent Corticosteroids
(Topical) |
Nonsteroidal Immunosuppressants (Topical) | Cytokine and Interleukin Inhibitors
(Biologic) |
| Clobex (0.05% clobetasol propionate) | ApexiCon E cream (0.05% diflorasone diacetate) | Cutivate cream/lotion (0.05% fluticasone propionate) | Protopic (tacrolimus) | Dupixent (dupilumab) |
| Ultravate cream (0.5% halobetasol propionate) | Elocon ointment (0.5% halobetasol propionate) | Dermatop cream (0.1% prednicarvate) | Elidel (pimecrolimus) | Actimmune (recombinant interferon 1b) |
| Vanos cream (0.1%) | Halog ointment (0.05% halobetasol propionate) | Pandel cream (0.1% hydrocortisone probutate) | Eucrisa (crisaborole) | |
| Topocort cream/ointment (0.25% desoximetasone) | Synalar cream (0.025% fluocinonide acetonide) | |||
| Lidex-E cream (0.05% fluocinonide) | Aclovate cream/ointment (0.05% alclometasone dipropionate) | |||
| Topocort LP cream (0.05% desoximetasone) | Verdeso foam (0.05% desonide) | |||
| Cloderm cream (0.1% clocortolone pivalate) | Desonate gel (0.05% desonide) | |||
| Elocon cream (0.1% mometasone furoate) | Aristocort A cream (0.025% triamcinolone acetonide) | |||
| Aristocort A cream (0.1% triamcinolone acetonide) | Kenolog ointment (0.025% triamcinolone acetonide) | |||
| Kenolog ointment/lotion (0.1% triamcinolone acetonide) | Locoid cream/ointment (0.01% hydrocortisone butyrate) | |||
| Valisone ointment (0.1% betamethasone valerate) | Derma-Smoothe/FS oil (0.01% fluocinonide acetonide) | |||
| Synalar cream (0.25% fluocinonide acetonide) | Nutracort lotion (2-2.5% hydrocortisone) | |||
| Topocort cream/ointment (0.05% desoximetasone) | Synacort cream (2-2.5% hydrocortisone) | |||
| Cortaide OTC products (0.5-1% hydrocortisone) |
For more information visit National Eczema Association or the AD page at the American Academy of Dermatology.
To watch a video produced by the American Academy of Dermatology demonstrating the Bleach Bath recipe for minimizing infection risk of AD click here.
To request information from Qualmedica Research about enrolling an AD clinical trial check out our Studies Page.