Emollients
Patients with atopic dermatitis have dry skin even when
they don't have much obvious inflammation. The dry skin is itchy
and uncomfortable and if left untreated predisposes to more dermatitis.
It is important that patients are taught to keep their skins moist
and supple. They should use some emollient preparation as often
as this is necessary for their comfort. The particular emollient
chosen should be the one that they find most helpful and least unpleasant
to use. The most efficient emollients contain more white soft paraffin
but these tend to be the most greasy. Apart from emollient applications
they should use a soap substitute with an emollient effect. Bath
oils are also helpful in many patients (e.g. Oilatum bath emollient
or Balneum).
Typical atopic dermatitis is frequently accompanied by dry scaling skin (xeroderma).This causes considerable discomfort in some patients.
Chronic persistent lichenified dermatitis. This type of dermatitic rash frequently benefits from applications containing tar
Topical corticosteroids
For the dermatitis patches
themselves the mainstays of treatment are the topical corticosteroids.
The least potent preparations that produce improvement should be
chosen. Atopic dermatitis tends to last for some years and there
are serious dangers from the absorption of the corticosteroid if
its application is continued. For this reason corticosteroids should
only be used when the dermatitis is active.
Dry skin in atopic dermatitis
Hydrocortisone preparations
are the most suitable but other weak corticosteroids, such as clobetasone
butyrate (Eumovate) or 1 per cent hydrocortisone and 10 per cent
urea (Alphaderm), may also be used. More potent corticosteroids
should only be used for stubborn areas if needed, and then only
for short periods.
Traditional treatments
Some of the older remedies
should be given a chance. Weak tar preparations quite often exert
a beneficial effect, especially on the more persistent thickened
patches. Even zinc cream and oily calamine lotion can help some
patients. Bandaging may be helpful if it's a matter of preventing
the creams or ointments from soiling the clothes or bed linen. They
should not be used to restrain a child - the frustration of not
being able to scratch an itch is worse than the damage to the skin
caused by scratching.
Antihistamines
There is no place for topical
antihistamines in the treatment of atopic dermatitis. They are not
antipruritic in eczema and may irritate or even cause sensitization
reactions. Systemic antihistamines of the older type are often prescribed
to allay the itching. In fact the antihistamines seem to have very
little effect on itching when pharmacological tests are made but
agents such as dipthenhydramine; trimeprazine and chlorpheniramine
cause drowsiness and relieve symptoms in this way. Newer non-sedating
antihistamines such as terfenadine are not of much help to patients
with atopic dermatitis.
