Don’t Let Eczema Flare-Ups Get You Down

By Angie Seelal, RPA-C

Good sleep, fulfilling activities, close relationships, positive self-esteem – these can be casualties of atopic dermatitis, the chronic skin condition often called “eczema”. We’ve seen rates of atopic dermatitis – or ‘AD’ – climb.

Atopic dermatitis usually starts at a young age, most often under five. Dry, scaly, red patches of skin develop, often on the face, arms or legs. These affected areas are extremely itchy, interfering with sleep and triggering scratching that can bring additional skin problems: worsened inflammation and the risk of infection.

Following the first occurrence, symptoms may subside and flare up. About half of the children affected by eczema will see symptoms cease completely by adulthood. For others, the red, itchy patches can continue to interfere distressingly with work and play. (Editor’s note: According to the National Eczema Association, adults can develop eczema even though they never had it as a child.)

Since the 1970s, AD cases have increased, with some industrialized countries’ numbers tripling. Research has yet to fully identify why, but in the U.S., about 9.6 million of those under eighteen have AD, and more than 16 million adults are dealing with the condition.

Atopic dermatitis is not contagious, despite its appearance. Research points to a confluence of genes and environment that trigger an immune system misfire. Genetically, there is a connection between AD, asthma, and hay fever; parents with any one of these conditions are more likely to have children who develop AD. Research has also focused on the skin protein “filaggrin”, which helps maintain a protective skin barrier. A mutation in the gene that codes for filaggrin may be implicated in AD.

At this point, there is no cure for AD. But we have effective treatments that can help patients control symptoms. And early treatment can ward off long-term damage, like lichenification – the skin thickening that can result from chronic scratching.

To help patients manage AD, I suggest the following:

Six Tips to Help Control Atopic Dermatitis

1. Moisturize, moisturize, moisturize:

   Dry skin is the enemy, and we also want to build up the skin’s protective barrier. With AD, a super-effective moisturizer is needed. Ointments’ higher oil content provides the most protection. People should avoid any additives that may be irritants. Ask your dermatologist. And the National Eczema Association’s website has a list of evaluated products. Do a trial run on a small spot to check for sensitivity. Your moisturizer should be handy at every household sink for post-washing and packaged to go for re-application when out and about.

2. Bathe smart:

   An effective bath or shower routine helps us maximize moisturizing. “Effective” means lukewarm water instead of hot, using a gentle cleanser for sensitive skin, and staying away from scrubbing and soap. Then we’re set up for moisturizing.

3. Follow the three-minute rule:

   After washing, we’re primed to moisturize, but we need to do this in a timely way. An oil-rich moisturizer should be applied within three minutes to seal in moisture. If we have topical medications, those should be applied first, followed by the moisturizer.

4. Topical treatments? Understand the options:

   Moisturizing is required. But often it’s not enough. Corticosteroids, topical calcineurin inhibitors (TCIs), and PDE4 inhibitors are topical treatments with different mechanisms for tamping down the body’s immune response to decrease inflammation. Patients should talk with their doctor to get a clear understanding of how each medicine works and its side effects. Steroidal treatment, for example, is often limited, while TCIs may be long term.

5. Light therapy requires a commitment:

   Phototherapy – most often in the form of UVB rays – can help up to 70 percent of patients who haven’t improved with topical treatment. But it involves frequent ongoing treatments.

6. Learn about targeted “biologic” treatment:

   In 2017, the FDA approved Dupixent^® as the first ‘biologic’ drug for AD: It works on a genetic level to block proteins that trigger skin inflammation. Patients receive every-other-week injections.

Your dermatologist can help customize a plan so that AD doesn’t devastate your life.

Angie Seelal, RPA-C is a Certified Physician Assistant through the National Commission of Certification of Physician Assistants.

Advanced Dermatology P.C. and the Center for Laser and Cosmetic Surgery (New York & New Jersey) is one of the leading dermatology centers in the nation, offering highly experienced physicians in the fields of cosmetic and laser dermatology as well as plastic surgery and state-of-the-art medical technologies. www.advanceddermatologypc.com.