I was compensated by Med-IQ through an educational grant from Sanofi Genzyme and Regeneron Pharmaceuticals to write about the signs, symptoms, and treatments available for atopic dermatitis or eczema. All opinions are my own.
Growing up, I always heard about eczema from friend’s experiences, but never knew much about it until a few years ago. When one of my children began experiencing symptoms of eczema at a young age, I realized I needed to learn more. This is one of the reasons that I decided to work with Med-IQ. My hope is to generate awareness around signs of eczema/atopic dermatitis and treatment options. So if you aren’t very familiar with eczema, you can read about it in this post. Today I’m sharing what to do if you or someone you love is experiencing moderate to severe eczema.
Moderate to Severe Eczema
Atopic dermatitis is one of several eczema conditions. It is chronic and, therefore, more challenging to manage. If your atopic dermatitis is not resolving you should seek treatment or consider a treatment change. There are new, effective options available for more severe atopic dermatitis. In addition, if you feel that your treatment is not satisfactory, it may be time to switch providers. Here are some useful statistics:
- Although atopic dermatitis most commonly develops early in life. It can persist into adulthood for many patients
- 10% to 25% of children have atopic dermatitis; of which, approximately one-third have moderate-to-severe disease
- 5% to 10% of adults have atopic dermatitis (3% of elderly); of which, approximately one-third have moderate-to-severe disease
- Atopic dermatitis is also associated with several mental health conditions, including ADHD, anxiety, and depression (the latter likely due from the distress atopic dermatitis causes)
Unfortunately, eczema often worsens as we enter the coldest months of the year. The lack of vitamin D from the sun in the winter months can play a role in increasing eczema symptoms. If you or a loved one has eczema, it’s helpful to think of the treatment journey as a therapeutic ladder based on the severity of your atopic dermatitis. You start on the lowest levels to see what works (or doesn’t work) and then work your way up as needed.
Basic Skin Care
If we think about that ladder of treatment, the first step is gentle skin care treatments. In fact, it is suggested to use gentle soap and cleansers. These should be oil-based, preservative-free, and moisturizing for the skin. The key is to identify and avoid possible allergens that may trigger and/or aggravate flare ups. Some common triggers are:
- certain foods such as dairy, eggs, and fish
- wool or coarse fabrics
It can be challenging to identify these irritants. You can speak with your healthcare provider and schedule an allergy test if needed.
Topical therapies (mild or moderate atopic dermatitis)
Often, the second step of the treatment ladder is corticosteroids. Using these long-term is not recommended. And they should not be used on sensitive places such as the diaper area or face. Steroids are best for mild or moderate atopic dermatitis. Corticosteroid-sparing therapies are available that can be used on these sensitive areas or if basic management strategies don’t work.
If steroids or other topical therapies are not healing your eczema, you may have moderate to severe atopic dermatitis and need to move up the treatment ladder. One treatment option for this is nonspecific immunosuppressants, such as systemic corticosteroids. However, these can cause rebound flares and multiple adverse effects with long-term use.
There are other immunosuppressant therapies that can be prescribed. But these have not been approved by the FDA. Newer systemic agents are now available that are approved by the FDA. These target the underlying cause of atopic dermatitis.
In addition, dupilumab which is FDA approved for patients ages 6 and older. This is used on moderate to severe atopic dermatitis that is not controlled by topical therapies.
Eczema Action Plan and Providers
Atopic dermatitis is a chronic condition. And so a formal written eczema action plan is good to have. This can help you follow your recommended plan for management. As with any medication, it’s always important to follow treatment instructions carefully. This is so if your symptoms don’t improve or you experience side effects, you will know and be able to inform your doctor. Notifying your skin care provider will let them know if a treatment plan change may be necessary.
If you are a parent who’s child is experiencing eczema, you may be wondering if you should see a pediatrician or a dermatologist. But this is really a case by case basis. Some pediatricians aren’t comfortable treating up the ladder, while others are. I suggest getting advice from both your pediatrician and pediatric dermatologist.
It’s really important for you or your family member to find a healthcare provider who you trust. The journey of treatment should be a partnership. When seeking out a provider, look for clinicians who ask what your preferences are and take the time to discuss your prior experiences so that you can create the best eczema treatment plan for you.
If you would like to learn more about moderate to severe eczema, here are a couple more resources for you:
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