Eczema types: Atopic dermatitis diagnosis and treatment

Dermatologists recommend moisturizer for everyone who has atopic dermatitis

Keeping your skin well moisturized helps to prevent cracks and fissures in your skin that could lead to a worsening rash, itching, or infection.

How do dermatologists diagnose atopic dermatitis?

To diagnose atopic dermatitis, also called eczema, a board-certified dermatologist carefully examines your (or your child’s) skin and asks questions.

Before your appointment: It’s helpful to find the answers to the following questions:

• Do any of your blood relatives have atopic dermatitis, asthma, or hay fever?

• What are your (your child’s) symptoms?

• When did the symptoms begin?

• Where does the atopic dermatitis appear on your (your child’s) skin?

Having the answers to these questions provides your dermatologist with important information. Atopic dermatitis tends to wax and wane, so your skin may not be at its worst when you see your dermatologist, and that’s okay.

A skin exam along with information about your health and symptoms may be all your dermatologist needs to give you a diagnosis. Sometimes, a skin biopsy is required to make sure you have atopic dermatitis.

A skin biopsy can also help your dermatologist select the best treatment.

How do dermatologists treat atopic dermatitis?

This condition cannot be cured, but proper treatment can control it. A treatment plan created by a board-certified dermatologist can help:

• Reduce flare-ups

• Ease symptoms, such as itch and pain

• Prevent atopic dermatitis from worsening

• Decrease your risk of developing thickened skin, which tends to itch all the time

• Keep your skin hydrated

• Lower your risk of infection

While a dermatologist tailors each treatment plan to a patient’s individual needs, most treatment plans include one or more of the following:

Skin care: A skin care plan for atopic dermatitis involves:

• Bathing

• Applying moisturizer

• Being gentle with your skin

Your dermatologist will explain how to use baths and moisturizer to help heal your skin.

Occasionally, dermatologists recommend wet wrap therapy. If this is recommended, you would:

• Apply moisturizer or medication to the skin with atopic dermatitis.

• Wrap the treated skin in a layer of wet bandages or damp, tight-fitting pajamas.

• Place dry bandages or pajamas over the wet layer.

Wet wrap therapy can help the skin absorb medication and keep the skin hydrated. This, in turn, can reduce flare-ups. The wraps also protect the skin from scratching.

If wet wrap therapy is right for you, your dermatologist will create an individualized wet wrap routine.

Trigger management: Atopic dermatitis can make the skin very sensitive and very reactive. Things that your skin comes into contact with every day can cause flare-ups. Anything that causes atopic dermatitis to flare is known as a trigger.

Different people have different triggers. If you can find your triggers and avoid them, this can help reduce flare-ups. Keep in mind that some people may not be able to find specific triggers.

Common triggers include skin care products, weather (cold or hot), wool clothing, stress, perfumes, and laundry detergents that contain fragrance.

Your dermatologist can help you figure out your triggers. If you want to learn more about triggers, go to: Eczema triggers.

Medication applied to the skin: When used with the right skin care and trigger management, most people can control atopic dermatitis with medication that they apply to their skin. When this is part of your treatment plan, you may apply one or more of the following:

• A corticosteroid cream, ointment, or other form that you apply to your skin: Many treatment plans include this type of medication, which can quickly relieve symptoms. To learn more, go to Eczema treatment: Corticosteroids applied to the skin.

• Pimecrolimus cream (Elidel) or tacrolimus ointment (Protopic): Also known as topical calcineurin inhibitors (TCIs), your dermatologist may prescribe one of these medications if corticosteroids stop working, fail to work, or are not a good option for you. To find out more, go to: Eczema treatment: Topical calcineurin inhibitors (TCIs).

• Crisaborole ointment (Eucrisa): Approved to treat patients 3 months of age or older, crisaborole can be used on many areas of the skin. To learn more, go to: Eczema treatment: Crisaborole ointment.

• Ruxolitinib cream (Opzelura): This medication is approved to treat patients 12 years of age or older, who have mild to moderate atopic dermatitis. To find out more, go to: JAK inhibitors: What your dermatologist wants you to know.

• Roflumilast cream (Zoryve): This medication is approved to treat patients 6 years of age and older who have mild to moderate atopic dermatitis. It’s reported that it doesn’t sting or burn when applied. In clinical trials, more than 40% of patients aged 6 and older were clear or almost clear after using roflumilast for 4 weeks. Some patients had less itch 24 hours after starting this medication.

Applying medication to your skin as directed can improve your skin’s ability to keep out germs and everyday substances that can irritate it. This means fewer flare-ups. The medication should also improve your skin’s ability to lock in moisture, so you’ll have fewer cracks and fissures.

Research breakthroughs are giving patients with atopic dermatitis new ways to treat this condition.

While medication you apply to your skin helps most patients, some people need stronger treatment. For them, a dermatologist may prescribe light therapy or a medication that works throughout the body.

Light therapy: This treatment uses special light bulbs or a laser. It can safely and effectively treat atopic dermatitis, even in children.

To receive light therapy, you’ll go to a dermatologist’s office, hospital, or phototherapy treatment center. Some patients may have the option of using a home light device.

For light therapy to be effective, you’ll need 2 to 3 treatments per week for the amount of time prescribed by your dermatologist. If your dermatologist recommends a type of light therapy called phototherapy, this often means going to the treatment center 2 to 3 times per week for a few weeks to a few months.

Should you find it difficult to keep these appointments, tell your dermatologist. Don’t try tanning beds, sunlamps, or sitting in the sun. If you get overheated or sunburned, you can have a flare-up. You can also damage your skin and increase your risk of developing skin cancer.

Medication that works throughout your body: Thanks to research breakthroughs made by dermatologists and other scientists, people with atopic dermatitis now have systemic (works throughout the body) treatments that have been approved by the U.S. Food and Drug Administration (FDA). The first such treatment was approved in 2017.

These FDA-approved treatments help people with moderate to severe atopic dermatitis see clearer skin and get relief from the itch. Systemic medications approved to treat atopic dermatitis include:

• Dupilumab (Dupixent®): This medication is a biologic. It’s FDA approved to treat patients 6 months of age or older who have moderate or severe atopic dermatitis that isn’t well controlled with medication applied to the skin.
  
  Dupilumab works by reducing inflammation that is thought to lead to atopic dermatitis flares. It doesn’t suppress the immune system, so it doesn’t increase the risk of developing a serious infection like tuberculosis (TB).
  
  Dupilumab is given as an injection. You may be taught how to inject this medication so that you can treat yourself or your child at home. Children under 12 years of age should be given these injections by a caregiver or receive them in a doctor’s office.
  
  In the studies that led to FDA approval of dupilumab, the most common side effects were mild. They included a reaction where patients had the medication injected, inflamed eyes (red and itchy) and eyelids, and cold sores.
  
  This medication may be prescribed with a corticosteroid that you apply to your skin or alone. In the research studies that led to FDA approval of dupilumab, patients receiving both medications saw more clearing of their skin and had noticeably less itch.

• Abrocitinib (Cibinqo™), upadacitinib (Rinvoq®): These medications are called JAK inhibitors. They work by reducing the inflammation that’s believed to cause atopic dermatitis.
  
  Both abrocitinib and upadacitinib are FDA approved to treat moderate to severe atopic dermatitis when other treatments fail to work.
  
  Both of these JAK inhibitors come in tablet form and are usually taken once a day.
  
  To learn more about these medications, go to: JAK inhibitors: What your dermatologist wants you to know.

• Tralokinumab-ldrm (Adbry™): This biologic medication is FDA approved to treat adults who need stronger medication than a topical (applied to the skin) medication can provide. This medication is injected into the skin, so patients learn how to give themselves an injection.
  
  To give you faster relief, your dermatologist may prescribe this medication along with a corticosteroid that you apply to your skin.

Before the above medications were available, patients who needed treatment that works throughout the body were treated with medications that could suppress the immune system. Today, this is still the preferred treatment for some patients. These medications include:

• Azathioprine

• Cyclosporine

• Methotrexate

• Mycophenolate mofetil

How dermatologists treat a skin infection

People who have atopic dermatitis are more prone to skin infections. If you have an infection, your dermatologist may prescribe:

An antimicrobial: This medication helps treat the infection as quickly as possible and prevent it from spreading. Your dermatologist may prescribe an antimicrobial that you apply to the skin or take by mouth. Use this medication exactly as prescribed.

While an antimicrobial can treat the infection, it cannot treat atopic dermatitis.

Bleach-bath therapy: Adding a small amount of bleach to a bath, such as one teaspoon of bleach per gallon of water to a toddler tub, may reduce bacteria and inflammation on the skin. Decreasing both can reduce symptoms.

Only use this treatment if your dermatologist recommends it.

What is the outcome for someone who has atopic dermatitis?

By partnering with a board-certified dermatologist, you can control atopic dermatitis. With control, it’s possible to relieve the extremely dry skin, alleviate the itch, and reduce flare-ups.

Sometimes, it takes trying a few different medications or light treatments to find the one that works best for you.

To get the best possible results from treatment, dermatologists recommend that you also practice eczema friendly skin care. To see the skin care that dermatologists recommend, go to: Atopic dermatitis: Skin care.

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References
Blauvelt A, Silverberg JI, et al. “Abrocitinib induction, randomized withdrawal, and retreatment in patients with moderate-to-severe atopic dermatitis: Results from the JAK1 Atopic Dermatitis Efficacy and Safety (JADE) REGIMEN phase 3 trial.” J Am Acad Dermatol. 2022;86(1):104-12.

Deleuran M, Thaçi D, et. al. “Dupilumab shows long-term safety and efficacy in patients with moderate to severe atopic dermatitis enrolled in a phase 3 open-label extension study.” J Am Acad Dermatol. 2020 Feb;82(2):377-88.

Eichenfield L, Boguniewicz M, et al. “P284: Once-daily roflumilast cream 0.15% for atopic dermatitis: Polled results: From INTEGUMENT-1/2 phase 3 trials.” Ann Allergy Asthma Immunol. 2023 Nov;131(5): Suppl 1, S91.

Newsom M, Bashyam AM, et al. “New and emerging systemic treatments for atopic dermatitis.” Drugs. 2020 Jul;80(11):1041-52.

Paller AS, Butala S, et al. “Treatment of atopic dermatitis (eczema).” UpToDate. Last updated: 6/5/2024. Last accessed: 8/2/2024.

Simpson EL, Leung DYM, et al. “Atopic dermatitis.” In: Kang S, et al. Fitzpatrick’s Dermatology. (ninth edition) McGraw Hill Education, United States of America, 2019:363-84.

Simpson EL, Papp KA, et al. “Efficacy and safety of upadacitinib in patients with moderate to severe atopic dermatitis: Analysis of follow-up data from the Measure Up 1 and Measure Up 2 randomized clinical trials.” JAMA Dermatol. 2022;158(4):404-13.

Wollenberg A, Blauvelt A, et al. “ECZTRA 1 and ECZTRA 2 study investigators. Tralokinumab for moderate-to-severe atopic dermatitis: Results from two 52-week, randomized, double-blind, multicentre, placebo-controlled phase III trials (ECZTRA 1 and ECZTRA 2).” Br J Dermatol. 2021 Mar;184(3):437-49.

Written by:
Paula Ludmann, MS

Reviewed by:
DiAnne Davis, MD, FAAD
Elisa Gallo, MD, FAAD
Elaine T. Kaye, MD, FAAD
William Warren Kwan, MD, FAAD
Shari Lipner, MD, PhD, FAAD
Ata Moshiri, MD FAAD
J. Klint Peebles, MD, FAAD

Last updated: 8/22/24