Atopic dermatitis (AD)
The treatment of AD can be divided into several categories:
- A reduction of trigger factors is necessary including chemicals, detergents, wool, house dust mites, pollen (tree, grass, weed), animal dander (cat, dog), moulds and avoidance of occupations that bear contact with trigger factors such as hairdressing, health care and construction. The role of house dust mites is discussed controversially but its reduction in the bedroom was most strongly related with improvement. With increasing age, the importance of food allergens such as milk, egg white, peanuts and soybeans rapidly decreases. The frequency of aeroallergens increases with age and cross allergies to certain foods may occur. These type I allergies must be identified by prick testing. In case of positive reactions to food allergens, specific diet guidelines must be followed and these foods must be avoided.
- General treatment strategies should be followed. Avoidance of skin drying (xerosis) by frequent use of emollients is a mainstay of therapy of AD.
- In case of bacterial or fungal superinfection, topical antimicrobials are beneficial for a certain period of time (see “Topical Antifungals” and “Topical Antimicrobials/Antiseptics”).
- Topical corticosteroids are the first line therapy for moderate to severe AD and should be applied in different patterns according to the specific localisation (see “Treatment in specific localisations”).
- Topical immunomodulators are used as second-line treatment for AD with good success.
- In case of dyshidrosis/hyperhidrosis, local tap water iontophoresis should be performed in hands and feet.
- Systemic antihistamines, especially the sedating ones, are helpful in patients in whom itching prevents sleep or in those who scratch during the night. The value of H1 antihistamines in the treatment of AD is controversary in clinical studies and evidence is still lacking.
- In severe, chronic and therapy-resistent forms of AD, systemic cyclosporine may be suggested.
- In severely exacerbated cases, short-term use of systemic corticosteroids may be indicated for relief of acute symtoms but this is not a therapeutical regimen for long-term use, especially not in chronic forms of severe AD.
- Numerous phototherapy regimens have been reported to improve AD. Phototherapy in AD is clearly beneficial in appropriate patients under professional supervision in addition to topical treatment. Therapeutic success depends upon proper selection of the phototherapy in recognition of the disease state. The choice of an appropriate phototherapy regimen is to be made by a dermatologist considering the patient’s individual constitution and needs.
According to a systematic review of treatments for AD, insufficient evidence was found for antihistamines, topical coal tar and topical doxepin.