How can your atopic patients relieve their pruritic agony and discomfort? - Avoid provoking factors (scrubbing, bathing .10 minutes, hot water bathing, scented soaps, irritating clothing, low humidity, temperature extremes, copious sweating, etc.).
- Moisturize by hydrating the skin and then applying moisturizers within 3 minutes of bathing to prevent evaporation. Moisturizers containing ceramide, such as CeraVe, or glycerin, such as Vaseline Intensive Rescue products, are especially beneficial in atopic patients. Alpha-hydroxy acid products often sting and burn in dermatitis patients.
- Limit soap use to mild, unscented soaps on hairy or oily areas.
- Wear 100% cotton clothing as much as possible, and if the arms and forearms are affected during dry seasons, wear long-sleeved shirts to reduce evaporation from the skin.
- During dry times of the year, use a humidifier to keep the humidity between 35% to 40%.
- Topical corticosteroids are the treatment of choice for subacute or chronic lesions.
- Twice-daily use or corticosteroids is only minimally more effective than once-daily use, but application in the evening is more effective than application in the morning!
- Corticosteroids can be safely used on skin colonized by bacteria.
- Younger patients require less potent steroids than older patients. Use occlusive vehicles (ointments, emollient creams) on dry and/or exposed lesions; use nonocclusive vehicles (creams, lotions, foams, liquids) on moist or occluded areas. Foams have the highest level of patient compliance among all vehicles.
- For acutely inflamed and weeping skin, use wet-to-dry compresses because they are soothing, antipruritic, cleansing, hydrating, and cooling. Use a topical corticosteroid with this for improved effectiveness.
- A new class of topical agents, calcineurin inhibitors, includes tacrolimus and pimecrolimus and can be safely used by following the Food and Drug Administration (FDA) guidelines.
- If lesions are secondarily infected, antibiotic therapy for 2 weeks should be prescribed. Antibiotics should not be used if clinical infection is not present.
- Severe atopic dermatitis may require systemic treatment with cyclosporine, azathioprine, methotrexate, or mycophenolate mofetil.
- Ultraviolet A-1 (UVA-1), ultraviolet B (UVB), and psoralen plus ultraviolet A (PUVA) phototherapy are also effective for more severe cases of atopic dermatitis.
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