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Can anything relieve severe atopic dermatitis?

If you're living with severe atopic dermatitis (AD), relief is possible. With help from a board-certified dermatologist, you can get a treatment plan that will help you:

  • Follow an effective skin care plan

  • Avoid triggers

  • Use medication safely

  • Find and care for related diseases

What exactly is severe AD?

AD is the most common type of eczema. When this eczema becomes severe, a person has patches of skin that are red, swollen, and unbearably itchy. The patches of AD can weep fluids. Skin infections are common.

Severe AD tends to impact a person’s quality of life. The intense itch can waken a child or adult from a sound sleep and keep the person awake for hours. This can make it hard for a child to focus at school. An adult may have trouble keeping up at work.

Severe atopic dermatitis

This patient has severe atopic dermatitis on the knees. Carefully following a customized treatment plan often helps relieve severe AD.

severe atopic dermatitis knees

Living with severe AD often means you cannot do many things. One woman equates having severe AD with being in prison. She desperately wants to pick up her grandchildren and swing them in the air, but her hands hurt too much to do that. She would enjoy having people over for dinner, but she cannot imagine anyone wanting to take a plate of food from someone who has bloody, flaky hands.

Living with severe AD can take a toll on your mental health. Not being able to do many things and coping with the itch and pain can lead to depression and anxiety.

How do dermatologists treat severe AD?

Each patient with severe AD receives a personalized treatment plan.

To create this plan, your dermatologist will want to know how long you’ve had AD, your response to past treatments, and your preferences for treating AD.

Even for severe AD, treatment often begins with the basics — skin care, trigger management, and medication.

For treatment to work, it’s equally important to find out if you have any other medical conditions. If you have an undiagnosed medical condition, it may prevent your AD treatment from working.

Here’s what you can expect if you see a board-certified dermatologist for severe AD.

Skin care builds a foundation for effective treatment

Skin care plays an important role in helping the skin heal. A skin care plan for severe AD often includes baths and moisturizer.

Baths and showers help to:

  • Hydrate extremely dry skin

  • Get rid of crusts and scales

  • Remove microscopic particles on the skin that may be irritating you or causing an allergic reaction

If you have frequent skin infections, your dermatologist may prescribe bleach baths. Adding a small amount of bleach to your bath water can help reduce the bacteria on your skin.

Learn more at: Bleach bath therapy

Moisturizer helps trap water in your skin. Studies show that applying a moisturizer after bathing (within 3 minutes of getting out of the water) and frequently throughout the day can:

  • Reduce extremely dry skin

  • Lessen the itch and other symptoms

  • Reduce redness and swelling

  • Help heal cracks in the skin

  • Prevent thickening of the skin

Researchers have found that using moisturizer frequently can reduce severe eczema. It may also reduce the need for medication.

With so many moisturizers available, your choices can feel overwhelming. Your dermatologist can recommend moisturizers that work for you without irritating your skin.

Learn more at: Why are baths and moisturizer so important when treating eczema?

Trigger management can help prevent flare-ups

A trigger is anything that aggravates your skin, causing new AD to appear or existing AD to worsen. 

Many things can trigger AD, including dry air, sweat, and stress. What triggers your AD may not trigger someone else’s AD. It’s also possible for your triggers to change.

Knowing your triggers and avoiding them can help prevent AD from flaring. A board-certified dermatologist can help you find your triggers and offer tips for avoiding them.

You’ll find information about common triggers at: Triggers can cause eczema to flare.

Medication is often necessary to treat severe AD

Patients with severe AD often need medication along with skin care and trigger avoidance to get relief.

Medication that you apply to your skin may be part of your treatment plan. To increase how well this medication works, your dermatologist may recommend that you apply the medication and then cover your skin with a gauze bandage or wet pajamas.

Only cover your skin if your dermatologist recommends it. For this to be safe and effective, proper technique is essential.

Follow a treatment plan

For treatment to work, you must follow your treatment plan.

Infant treated for eczema

If you have severe AD, stronger medication may be required. One option for treating severe AD is light treatments. Your dermatologist may call this phototherapy.

For phototherapy to be effective, you must go to a treatment center 2 to 3 times per week for several weeks. For this reason, light treatments may not be a realistic option for some people.

Another option may be to take medication that works throughout the body.

You can learn more about treatment for AD at: Atopic dermatitis: Diagnosis and treatment

Finding an undiagnosed medical condition can make AD treatment effective

If you have an undiagnosed medical condition, such as a skin allergy, your AD treatment plan may not work. That’s why board-certified dermatologists treat the whole person.

A dermatologist can look for signs and symptoms of other conditions and refer you to other specialists as needed. This helps ensure you get the treatment you need to feel better.

Severe AD often requires expertise 

A treatment plan for severe AD can have many parts. A board-certified dermatologist can tailor a treatment plan to meet your needs. While that may not completely eliminate severe AD, it can help you feel better.

Image 1: Used with permission of the American Academy of Dermatology National Library of Dermatologic Teaching Slides.

Image 2: Getty Images

Eichenfield LF, Tom WL, et al. “Guidelines of care for the management of atopic dermatitis. Section 2. Management and treatment of atopic dermatitis with topical therapies.” J Am Acad Dermatol. 2014;71:116-32.

Kalb RE and Weinberg JM. “Atopic dermatitis: New perspective on managing a chronic inflammatory disease.” Global Education Group and Integritas Communications. Released: July 1, 2017.

Sidbury R, Davis DM, et al. “Guidelines of care for the management of atopic dermatitis Section 3. Management and treatment with phototherapy and systemic agents.” J Am Acad Dermatol. 2014;71:327-49.

Simpson EL, Bruin-Weller M, et al. “When does atopic dermatitis warrant systemic therapy? Recommendations from an expert panel of the International Eczema Council.” J Am Acad Dermatol. 2017 Oct;77:623-33.

Thyssen JP, Skov L, et al. “Assessment of major comorbidities in adults with atopic dermatitis using the Charlson comorbidity index.” J Am Acad Dermatol. 2017;76:1088-92.