When atopic dermatitis (also known as eczema) is milder, there’s a good chance you can control the itchy, red patches using over-the-counter moisturizers and bathing. A topical steroid ointment helps when your skin flares up. But if your atopic dermatitis is moderate or severe, those simple steps may not be enough. Even for doctors, treating severe atopic dermatitis can be a challenge. But you’ll have more options to find relief now than you would have just a couple of years ago.
How Is Moderate to Severe Atopic Dermatitis Treated?
It’s best to tackle your moderate to severe atopic dermatitis in multiple ways at once. This includes:
- Learning about your atopic dermatitis and how to manage it.
- Avoiding things that make it worse.
- Healing and moisturizing your skin.
- Using medicines your doctor prescribes.
- Treating any allergies or other conditions you have that might be related.
What Are the Treatments for Moderate to Severe Atopic Dermatitis?
When your atopic dermatitis is moderate to severe, you’ll likely need medicine to keep it controlled. Doctors usually try topical medicines first. These may include corticosteroids. You also could try topical medicines known as calcineurin inhibitors. If your skin is infected, your doctor might give you an antibiotic cream or have you take antibiotics by mouth to get rid of it.
Sometimes these medicines might be enough. But when moderate to severe symptoms continue despite topical treatments, it’s time to look into other options. These include light therapy and medicines that you’ll either take by mouth or your doctor will show you how to inject under your skin.
Light Therapy for Moderate to Severe Atopic Dermatitis
Light therapy, also known as phototherapy, comes in different forms. Experts recommend one called narrowband ultraviolet B over others when moderate to severe atopic dermatitis isn’t controlled with topical treatments.
You’ll usually get it two or three times a week. You might keep using topical corticosteroids along with phototherapy. Ask your doctor if you need extra moisturizer because phototherapy can dry your skin out more.
The downside of phototherapy is you will have to go somewhere to have it done multiple times a week. If you have phototherapy for a long time, it may increase your risk for skin cancer. It also may be costly. While it’s a good option and studies show it can help with moderate to severe atopic dermatitis, phototherapy isn’t always feasible.
Biologics and Other Medicines for Moderate to Severe Atopic Dermatitis
Drugs that suppress your immune system may help with atopic dermatitis. Immunosuppressants used for it include:
- Azathioprine
- Cyclosporine
- Methotrexate
- Mycophenolate mofetil
These days, your doctor might suggest skipping immunosuppressants in favor of medicines called biologics. You also could take a biologic if you tried drugs that suppress your immune system and they didn’t work. But biologics are generally safer and better if you need medicine for the long term.
Biologic medicines approved for atopic dermatitis include dupilumab and tralokinumab-ldrm. You’ll get dupilumab from your doctor in an injection 2 weeks apart. It works by binding a specific protein that blocks immune signals involved in atopic dermatitis.
You’ll start with a bigger dose and then get a maintenance dose every other week. You might keep using topical corticosteroids along with dupilumab. Ask your doctor about any side effects you should look for.
Tralokinumab-ldrm hasn’t been used to treat atopic dermatitis for as long as dupilumab. It’s also an injection. But it works by blocking a different protein that immune cells make. Talk to your doctor about which biologic it makes sense to try first.
Drugs called JAK inhibitors are another way to treat moderate to severe atopic dermatitis. You’re most likely to try these if other treatments including biologics haven’t worked for you or you can’t take them for some reason. You can choose from these JAK inhibitors: abrocitinib, ruxolitinib, and upadacitinib.
Doctors don’t know what happens if you take JAK inhibitors for atopic dermatitis for a long time. But there’s reason to think they may come with potentially serious or fatal health risks including:
- Infections
- Heart attack
- Stroke
- Cancer
- Blood clots
Don’t Forget Basic Skin Care
Even when you have moderate or severe atopic dermatitis and are taking medicine for it, basic skin care is still important. It’s likely you’ll still need to take medicine even if you do everything right, but you might not need to take as much. Ask your doctor what they recommend for you. A basic skin care plan for more severe atopic dermatitis has these steps:
Take regular baths or showers to:
- Help your skin stay hydrated.
- Wash away crusts and scales.
- Get rid of anything on your skin that might irritate it.
- If you get skin infections a lot, your doctor might suggest adding a small amount of bleach to your bath water.
Use a good moisturizer your doctor recommends when you get out of the bath or shower and other times throughout your day. This will help with:
- Dryness
- Itch
- Redness
- Swelling
- Cracks
- Thickening of your skin
What Else Helps With Moderate to Severe Atopic Dermatitis?
Having moderate to severe atopic dermatitis can be hard on your mental health. Anxiety and stress also can trigger a flare. Consider talking to a therapist or other counselor. Find other ways to help you relax and ease stress.
Each person with atopic dermatitis is different. Your doctor can help you come up with a plan that’s right for you. They’ll want to know how long you’ve had atopic dermatitis, what treatments you’ve tried, and how they worked for you. They’ll also want to know about your atopic dermatitis triggers and how you’d like to treat your atopic dermatitis. While you might not ever get rid of your atopic dermatitis symptoms, understanding your atopic dermatitis and using a combination of approaches can help.
Show Sources
Photo Credit: Ekaterina Goncharova / Getty Images
SOURCES:
Clinical, Cosmetic and Investigational Dermatology: “Treatment-Resistant Atopic Dermatitis: Challenges and Solutions.”
Mayo Clinic: “Atopic Dermatitis (Eczema).”
UpToDate: “Treatment of Atopic Dermatitis (Eczema).”
National Eczema Association: “Breaking News: FDA Approves Adbry (Tralokinumab-ldrm).”
American Academy of Dermatology Association: ‘Can Anything Relieve Severe Atopic Dermatitis?” “Stress: Is it a Common Eczema Trigger?”
