Eczema types: Atopic dermatitis diagnosis and treatment

Dermatologists recommend moisturizer for everyone who has eczema/atopic dermatitis

Keeping your skin well moisturized helps to prevent cracks and fissures in your skin that could lead to worsening rash, itching, or infection.

How do dermatologists diagnose eczema/atopic dermatitis?

To diagnose eczema, a board-certified dermatologist carefully examines your (or your child’s) skin and asks questions.

Before your appointment: It’s helpful to find the answers to the following questions:

• Do any of your blood relatives have eczema, asthma, or hay fever?

• What are your (your child’s) symptoms?

• When did the symptoms begin?

• Where do the rashes appear on your (your child’s) skin?

Having the answers to these questions provides your dermatologist with important information. Eczema tends to wax and wane, so your skin may not be at its worst when you see your dermatologist.

A skin exam along with information about your health and symptoms may be all your dermatologist needs to give you a diagnosis. Sometimes, a skin biopsy is needed to make sure you have eczema.

A skin biopsy can also help your dermatologist select the best treatment.

How do dermatologists treat eczema/atopic dermatitis?

This condition cannot be cured, but proper treatment can control it. A treatment plan created by a board-certified dermatologist can help:

• Reduce flare-ups

• Ease symptoms, such as itch and pain

• Prevent eczema from worsening

• Decrease your risk of developing thickened skin, which tends to itch all the time

• Keep your skin moist

• Lower your risk of infection

While a dermatologist tailors each eczema treatment plan to a patient’s individual needs, most treatment plans include one or more of the following:

Skin care: A skin care plan for eczema involves:

• Bathing

• Applying moisturizer

• Being gentle with your skin

Your dermatologist will explain how to use baths and moisturizer to help heal your skin.

Trigger management: Eczema can make the skin very sensitive and very reactive. Things that you come into contact with every day can cause flare-ups. Anything that causes eczema to flare is known as a trigger.

Everyone has unique eczema triggers, so it’s important to find your triggers and figure out how to avoid them. Common triggers include skin care products, weather (cold or hot), wool clothing, stress, perfumes, and laundry detergents that contain fragrance.

Your dermatologist can help you figure out your triggers. To learn more about these triggers, go to: Eczema triggers.

Your treatment plan may include medication that you apply to your skin, light treatments, medication that works throughout the body, or some combination of these. The following explains how these are used to treat eczema.

Medication applied to the skin: Most people can control eczema with medication that they apply to their skin. When this is part of your treatment plan, you may apply one or more of the following:

• A corticosteroid: Many eczema treatment plans include this type of medication, which can quickly relieve symptoms. To learn more, go to Eczema treatment: Corticosteroids applied to the skin.

• Pimecrolimus cream or tacrolimus ointment: Also known as topical calcineurin inhibitors (TCIs), your dermatologist may prescribe one of these medications if corticosteroids stop working, fail to work, or are not a good option for you. To find out more, go to: Eczema treatment: Topical calcineurin inhibitors (TCIs).

• Crisaborole ointment: Approved to treat patients 3 months of age or older, crisaborole can be used on many areas of the skin. To learn more, go to: Eczema treatment: Crisaborole ointment.

• Ruxolitinib cream: This newer medication is approved to treat patients 12 years of age or older. To find out more, go to: JAK inhibitors: What your dermatologist wants you to know.

• Coal tar: Used for more than 100 years to treat eczema, coal tar may be prescribed for some patients. To find out more, go to: Eczema treatment: Coal tar preparations.

Applying medication to your skin as directed can improve your skin’s ability to keep out germs and everyday substances that can irritate it. This means fewer flare-ups. The medication should also improve your skin’s ability to lock in moisture, so you’ll have fewer cracks and fissures.

Research breakthroughs are giving patients with eczema/atopic dermatitis new ways to treat this condition.

For most people, gentle skin care, trigger management, and medication that you apply to your skin can control eczema.

If you have an infection on your skin, your dermatologist will also treat this with medication that you take or apply to your skin.

While topical (apply to the skin) treatment helps most patients, some people need stronger treatment. For these patients, a dermatologist may prescribe light therapy or a medication that works throughout the body.

Light therapy: This treatment uses special light bulbs or a laser. It can safely and effectively treat eczema, even in children.

To receive light therapy, you’ll go to a dermatologist’s office, hospital, or phototherapy treatment center. Some patients may have the option of using a home light box.

For light therapy to be effective, you will need 2 to 3 treatments per week for the amount of time prescribed by your dermatologist. If your dermatologist recommends a type of light therapy called phototherapy, this often means going to the treatment center 2 to 3 times per week for a few weeks to a few months.

Should you find it difficult to keep your appointments, tell your dermatologist. Don’t try tanning beds, sunlamps, or sitting in the sun. If you get overheated or sunburned, you can have an eczema flare. You can also damage your skin and increase your risk of developing skin cancer.

Medication that works throughout your body: Thanks to research breakthroughs made by dermatologists and other scientists, patients now have systemic (works throughout the body) treatments that have been approved by the U.S. Food and Drug Administration (FDA). The first such treatment was approved in 2017.

These FDA-approved treatments are helping people with moderate to severe eczema see clearer skin and get relief from the itch. Systemic medications approved to treat atopic dermatitis include:

• Dupilumab (Dupixent®): This medication is a biologic. It’s FDA approved to treat patients 6 months of age or older who have moderate or severe eczema that isn’t well controlled with medication applied to the skin.
  
  Dupilumab works by reducing inflammation that is thought to lead to eczema flares. It doesn’t suppress the immune system, so it doesn’t increase the risk of developing a serious infection like tuberculosis (TB).
  
  Dupixent is given as an injection. You may be taught how to give yourself these injections so that you can treat at home. Children under 12 years of age should be given these injections by a caregiver or receive them in a doctor’s office.
  
  In the studies that led to FDA approval of dupilumab, the most common side effects were mild. They included a reaction where patients had the medication injected, inflamed eyes (red and itchy) and eyelids, and cold sores.
  
  This medication may be prescribed with a corticosteroid or alone. In the research studies that lead to FDA approval of dupilumab, patients receiving both medications saw more clearing of their skin and had noticeably less itch.

• Abrocitinib (Cibinqo™) and upadacitinib (Rinvoq®): These medications are called JAK inhibitors. They work by reducing the inflammation that’s believed to cause eczema.
  
  Both abrocitinib and upadacitinib are tablets. If your dermatologist prescribes one of these JAK inhibitors, you will take one pill a day.
  
  To learn more, go to: JAK inhibitors: What your dermatologist wants you to know.

• Tralokinumab-ldrm (Adbry™): This biologic medication has been FDA approved to treat adults who need stronger medication than a topical (applied to the skin) medication can provide. This medication is injected into the skin, so patients learn how to give themselves an injection.
  
  To give you faster relief, your dermatologist may prescribe this medication along with a corticosteroid applied to the skin.

Before the above medications were available, patients who needed treatment that works throughout the body were treated with medications that could suppress the immune system. Today, this is still the preferred treatment for some patients with eczema. These medications include:

• Azathioprine

• Cyclosporine

• Methotrexate

• Mycophenolate mofetil

What is the outcome for someone who has eczema?

By partnering with a board-certified dermatologist, you can control eczema. With control, it’s possible to relieve the extremely dry skin, alleviate the itch, and reduce flare-ups that lead to rashes.

Sometimes, it takes trying a few different medications or light treatments to find the one that works best for you.

To get the best possible results from treatment, dermatologists also recommend making some lifestyle changes. You’ll find the changes that dermatologists recommend at: Eczema/Atopic dermatitis: Self-care.

Images
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References
Blauvelt A, Silverberg JI, et al. “Abrocitinib induction, randomized withdrawal, and retreatment in patients with moderate-to-severe atopic dermatitis: Results from the JAK1 Atopic Dermatitis Efficacy and Safety (JADE) REGIMEN phase 3 trial.” J Am Acad Dermatol. 2022;86(1):104-12.

Deleuran M, Thaçi D, et. al. “Dupilumab shows long-term safety and efficacy in patients with moderate to severe atopic dermatitis enrolled in a phase 3 open-label extension study.” J Am Acad Dermatol. 2020 Feb;82(2):377-88.

Newsom M, Bashyam AM, et al. “New and Emerging Systemic Treatments for Atopic Dermatitis.” Drugs. 2020 Jul;80(11):1041-52.

Simpson EL, Papp KA, et al. “Efficacy and safety of upadacitinib in patients with moderate to severe atopic dermatitis: Analysis of follow-up data from the Measure Up 1 and Measure Up 2 randomized clinical trials. JAMA Dermatol. 2022;158(4):404-13.

Wollenberg A, Blauvelt A, et al. “ECZTRA 1 and ECZTRA 2 study investigators. Tralokinumab for moderate-to-severe atopic dermatitis: results from two 52-week, randomized, double-blind, multicentre, placebo-controlled phase III trials (ECZTRA 1 and ECZTRA 2).” Br J Dermatol. 2021 Mar;184(3):437-49.

Written by:
Paula Ludmann, MS

Reviewed by:
Laurel Geraghty, MD, FAAD
William Warren Kwan, MD, FAAD
Shari Lipner, MD, PhD, FAAD
Bassel Hamdy Mahmoud, MD, PhD, FAAD
Omolara Olowoyeye, MD, FAAD
Sanna Ronkainen, MD, FAAD
Mario J. Sequeira, MD, FAAD

Last updated: 1/31/23