The mainstay of treatment for atopic dermatitis, also known as eczema has been topical steroids for years. Atopic dermatitis has a prevalence in the United States between 9-18% of the population. Approximately 50% of the patients develop the disease in the first year of life and 30% between 1-5 years of age.
For many years the only known treatment besides moisturizing was topical corticosteroids. Over the last several years researchers have discovered different treatment options.
1. Bleach baths-The current recommendation is 0.005%. To reach this concentration, 1/4 cup of bleach is added to a half-filled 40 gallon bath. Twice weekly bathing showed that eczema severity significantly decreased. Other studies have shown no significant difference. Dry skin and burning are reported side effects. This has been used as a maintenance therapy for Staphylococcus overgrowth.
2. Vitamin D-Studies have shown the beneficial effects of Vitamin D on the innate immune response in patients with atopic dermatitis. Some studies have shown children with low Vitamin D have worse eczema. Patients who took Vitamin D daily for 3 weeks showed improved innate antimicrobial protection.
3. Systemic Immunomodulatory Agents– In severe eczema, oral steroids are effective but they should not be used long term because of side effects. Systemic immunomodulatory agents should be used instead. Cyclosporine A is effective but it needs to be monitored closely. Azathioprine has a slow onset of action and myleosuppression is a major potential adverse effect. Other treatments are mycophenolate mofetil and methotrexate. Interfern gamma has also been used in severe patients.
4. Phototherapy– This is also another useful tool in severe eczema. Narrow band UVB and broadband UVB are commonly used. Skin malignancy and premature aging are potential long term risks.
5. Allergy Specific Immunotherapy– Allergy shots can be effective for allergy induced eczema, they can be administered sublingually or subcutaneously. They have been show to decrease topical steroid usage. Studies have shown that patients with severe eczema showed significant improvements. A study showed patients with atopic dermatitis allergic to dust mite given shots for 1 year could alleviate eczema.
6. Biologic Therapy– Omalizumab (Xolair), a monoclonal anti-IgE antibody has been used for severe eczema. To date no studies show its efficacy for atopic dermatitis. Other ones that have been used are Anti-TSLP, Rituximab and dupilumab, but all are not ready for clinical usage yet.
In conclusion, atopic dermatitis is an inflammatory skin condition that can have a chronic course. Many patients are treated well with emollients or topical steroids. However severe eczema may require advanced treatment options.