From the Guidelines
Atopic dermatitis (eczema) is diagnosed based on clinical presentation and treated with topical corticosteroids as the mainstay of treatment, with emollients and education playing a crucial role in management.
Diagnosis
- The diagnosis of atopic dermatitis is based on the presence of dry skin, itching, and characteristic skin lesions, with consideration of the extent, location, and severity of eczema 1.
- Bacterial infection is suggested by the presence of crusting or weeping, while herpes simplex infection is indicated by grouped, punched out erosions, or vesiculation 1.
Treatment
- Topical corticosteroids are the primary treatment for atopic eczema, with the goal of using the least potent preparation required to keep the eczema under control 1.
- Emollients should be prescribed in adequate amounts and used liberally to help manage dry skin 1.
- Oral Janus kinase inhibitors (JAKi) may be considered for moderate-to-severe atopic dermatitis, but appropriate patient selection is important due to the risk of adverse effects 1.
- Avoidance of provoking factors, such as soaps, detergents, extremes of temperature, and irritant clothing, is also essential in managing atopic eczema 1.
- Education and explanation of the treatment plan, including demonstration of topical preparation application and provision of written information, are critical for effective management 1.
From the Research
Diagnosis of Atopic Dermatitis (Eczema)
- Atopic dermatitis is a chronic relapsing and remitting inflammatory skin disease that can be diagnosed based on symptoms and physical examination findings, as outlined by the American Academy of Dermatology 2
- The condition is caused by a complex interaction of immune dysregulation, epidermal gene mutations, and environmental factors that disrupt the epidermis, causing intensely pruritic skin lesions 2, 3
- Accurate diagnosis is critical to appropriate management and patient outcomes, and community nurses play a central role in enhancing the health and wellbeing of people with atopic eczema 3
Treatment of Atopic Dermatitis (Eczema)
- Maintenance therapy consists of liberal use of emollients and daily bathing with soap-free cleansers 2
- Topical corticosteroids are the first-line treatment for atopic dermatitis flare-ups, and should be used once daily rather than twice daily 4, 2
- Topical calcineurin inhibitors, such as pimecrolimus and tacrolimus, can be used in conjunction with topical corticosteroids as first-line treatment, and are useful for sensitive sites 4, 2, 5
- Ultraviolet phototherapy is a safe and effective treatment for moderate to severe atopic dermatitis when first-line treatments are not adequate 2
- Newer medications, such as crisaborole and dupilumab, are effective in treating atopic dermatitis, but are currently cost-prohibitive for most patients 2
- Proactive therapy with twice weekly use of both topical corticosteroids and calcineurin inhibitors in previously affected areas has been found to reduce the time to the next eczematous flare 5
Treatment Options to Be Avoided
- Oral antihistamines are not recommended as they do not reduce pruritus 4, 2
- Oral or topical antistaphylococcal treatments for infected eczema are not supported by evidence 4
- Probiotics are not effective in treating eczema 4
- Nonpharmacological treatments, including silk clothing, ion-exchange water softeners, and emollient bath additives, have not been shown to benefit eczema patients 4
- Emollients from birth do not prevent eczema and may result in harms such as increased skin infections and food allergy 4