ATOPIC DERMATITIS-ECZEMA

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What is Atopic Dermatitis?

Atopic dermatitis, also known as eczema, is a chronic (long-lasting) inflammatory disease that causes dryness, itchiness, redness, and irritation of the skin. It is a common condition that usually begins in childhood; however, anyone can get the disease at any age. In some cases, it improves after childhood, but in others persists into adulthood.  There is a genetic propensity, with disease clusters in families that also have asthma and seasonal allergies.  Atopic dermatitis can also be exacerbated by environmental factors, dietary allergens, seasonal changes, skin dryness, microbial colonization and infection, and emotional stress. We provide our updated Diet and Lifestyle Guidelines and Dry Skin Care pdfs with useful recommendations for all initial atopic dermatitis consultations.  

Topical Treatments

It is important to maintain skin moisture and support the skin's barrier function by proper cleansing and moisturizing. In addition, there are over-the-counter and prescription topical agents that we employ:

• anti-itch and anti-inflammatory creams.  We favor the use of non-cortisone treatments whenever possible, including:
• Elidel (pimecrolimus) 
• Protopic (tacrolimus)
• Eucrisa (crisaborole)
• Opzelura (ruxolitinib)
• Topical antimicrobials when there is a microbial trigger   

Oral Treatments 

In addition to oral antihistamines for itch relief and oral antimicrobials for infected eczema, there are 2 new oral medicines recently approved for eczema, Rinvoq (upadacitinib) and Cibinqo (abrocitinib). These are extremely effective in more severe or widespread cases of atopic dermatitis, which cannot be controlled by topicals. However, they require periodic blood test monitoring and their risk of side-effects is higher:  risk of infection and certain tumors because they decrease the immune function; blood clots and cardiovascular events, especially in people over 50 with risk factors.