The Itchy, Red, and Dry: Treating Atopic Dermatitis
When is it necessary to upgrade from a surface-level treatment to one that effectively addresses whole-body skin issues? Discover how your dermatologist determines the appropriate course of action.
When should you consider advanced treatment for your AD?
🌡️ Does your skin feel like it’s on fire? Does it itch uncontrollably, making you want to scratch yourself into oblivion? 🤔 If so, you might be dealing with atopic dermatitis (AD), a common skin condition that can cause redness, discoloration, dryness, and intense itching. Don’t worry, though – there are plenty of treatment options available to help you find relief and restore your skin to its former glory. Let’s dive into the world of AD treatments and explore what’s out there.
Assessing the Severity of AD
Before we jump into the treatments, it’s important to gauge the severity of your AD. Dermatologists determine this by looking at the extent of your affected skin. The more inflamed areas you have, the more severe your condition. Additionally, the location and appearance of AD can provide insights into its severity. For instance, severe AD tends to be deeper red in color, but for individuals with darker skin, it may appear as discoloration or even lighter pigmentation. Thickened skin that breaks open easily is another sign that your AD requires more intensive treatment. Furthermore, if topical medicines haven’t been successful in controlling the redness, discoloration, and itch, more potent options may be necessary. AD itch can be so intense that it interferes with daily life, affecting your sleep and work.
🔍 Q: How can I tell if my AD is severe enough to require more intense treatment?
A: If your affected skin area is extensive, your AD is not responding to topical treatments, or the intense itch is disrupting your daily life, it may be time to discuss more advanced therapies with your dermatologist.
Creams, Ointments, and Light Therapy
When it comes to treating mild cases of AD, topical options usually take center stage. These include:
- Coal tar: A decades-old remedy that effectively treats AD and other skin conditions, soothing inflammation and reducing itchiness.
- Steroid creams: These help control itching and promote skin healing.
- Calcineurin inhibitors: Medications like pimecrolimus (Elidel) and tacrolimus (Protopic) reduce inflammation by suppressing the immune response.
- Crisaborole (Eucrisa): A newer ointment that eases inflammation, itching, and rashes in AD patients aged 2 and older. 🆕
For individuals with AD on larger body areas or resistant patches, phototherapy (light therapy) may be recommended. This treatment employs ultraviolet (UV) light to help clear the skin.
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🔍 Q: Are there any alternatives to steroid creams for treating AD?
A: Yes, several options exist, including calcineurin inhibitors and crisaborole (Eucrisa). These alternatives can help control inflammation and itching without the potential side effects associated with prolonged steroid use.
Going Beyond the Surface: Body-Wide Treatments
If topical treatments fall short or if your AD affects larger areas of your body, systemic medications may be necessary. Dermatologists often use certain drugs off-label to treat AD, meaning they are approved for other conditions but have shown efficacy in AD treatment as well. Some of these body-wide treatments include:
- Cyclosporine: This potent immunosuppressant is effective at reducing inflammation in the skin.
- Azathioprine, Methotrexate, Mycophenolate mofetil: These medications work similarly to cyclosporine, suppressing the overactive immune system response that contributes to AD.
💊 One drawback of systemic treatments is the potential for serious side effects, such as kidney or liver damage, high blood pressure, tremors, muscle pain, and electrolyte imbalances.
A Game-Changer for Moderate to Severe AD
In 2017, the FDA approved the first biologic drug for AD, called dupilumab (Dupixent). This groundbreaking treatment has revolutionized the management of moderate to severe AD in both adults and children aged 6 and older. Dupixent is administered as a subcutaneous injection every two weeks and works by blocking two proteins, interleukin-4 (IL-4) and interleukin-13 (IL-13), that contribute to AD-related inflammation.
🔥 Metaphor Alert! “If you think of the skin as being on fire, a medication like methotrexate or prednisone [a steroid] acts like a fire blanket. It smothers out the fire,” explains Dr. Strowd. “Whereas a medicine like Dupixent is like taking a fire extinguisher and shooting the source of the fire. It’s a much more specific target.” 🔥
In clinical studies, Dupixent demonstrated remarkable results, effectively clearing the skin, relieving itching, and improving the quality of life for AD patients. Over 50% of individuals reported a 75% reduction in symptoms after 16 weeks of treatment, with these improvements lasting long-term.
Dupixent is generally safe, with mild side effects like skin reactions at the injection site, cold sores on the mouth or lips, redness, swelling, itching of the eyes and eyelids, and pinkeye being the most common occurrences. However, one downside is its cost, which exceeds $3,200 per shot. The coverage and out-of-pocket expenses depend on your specific health insurance, as some providers may require you to try more affordable options before granting coverage for Dupixent.
🔍 Q: Are there any other biologic options available for treating AD?
A: Yes, tralokinumab-ldrm (Adbry) is another recently approved biologic that blocks interleukin-13. It is administered as a shot every other week and has similar side effects and costs to Dupixent. For those averse to injections, oral JAK inhibitors like abrocitinib (Cibinqo) and upadacitinib (Rinvoq) offer an alternative option.
Life-Changing Transformation
New treatments, such as Dupixent, have brought about a paradigm shift in the treatment of AD, offering hope to those who have long suffered from its debilitating effects. These innovations have made it possible for individuals with AD to achieve clear or nearly clear skin, drastically improving their quality of life.
🌟 Empathy Corner: According to Dr. Strowd, “It absolutely changes people’s lives when they have been suffering. It’s a very rewarding part of treating this disease in our modern era.” 🌟
Remember, everyone’s journey with AD is unique, and it’s vital to work closely with your healthcare provider to find the best treatment approach for you. Don’t hesitate to explore the available options and advocate for your well-being. Together, we can extinguish the fiery flames of AD and reclaim healthy, happy skin.
References
- Mayo Clinic: Atopic dermatitis (eczema)
- National Eczema Association: Dupixent for Atopic Dermatitis FAQ, FAQ – Adbry (Tralokinumab-ldrm), FAQ – Opzelura (Ruxolitinib) Cream, FAQ – Rinvoq (Upadacitinib), JAK Inhibitors Are Coming and They Are the Biggest Eczema Development in Years, Prescription Phototherapy
- Dermatology and Therapy: Systemic Treatment of Adult Atopic Dermatitis: A Review
- News release, FDA: New Drug Approvals
- News release, National Eczema Association: A New Treatment for Adults with Moderate-to-Severe Atopic Dermatitis
- Journal of the American Academy of Dermatology: Dupilumab shows long-term safety and efficacy in patients with moderate to severe atopic dermatitis enrolled in a phase 3 open-label extension study
- Dupixent: Dupixent Pricing and Insurance
🗣️ Let’s spread the word about treating AD and help others find relief! Share this article with your friends and family on social media, and together, we can conquer atopic dermatitis! 🌈✨
