Challenges of Atopic Dermatitis

By Shilpi Khetarpal, MD, as told to Sarah Ludwig Rausch

The path to getting a diagnosis of atopic dermatitis (AD) can be long. Many times, people have tried over-the-counter treatments, home remedies, or products that are marketed for eczema that may or may not help.

It can sometimes be a long journey, with trying a lot of things that don’t necessarily improve or relieve symptoms because the condition isn’t being treated properly. For example, I’ve heard people say they’ve read about the benefits of using something like apple cider vinegar on their skin. Even though it’s natural, apple cider vinegar can actually make the skin worse and make it more uncomfortable by causing irritation called irritant dermatitis.

Atopic dermatitis is a subset of eczema. We see it many times in people who have a personal or family history of eczema, seasonal allergies, or hay fever. Eczema is a broader term, but for the most part, the two terms are often used to mean the same thing.

Challenges and Changes

When you’re newly diagnosed with AD, there may be several challenges.

The first — and we see this all the time with our patients — is that you have to change everything you do in terms of caring for your skin. You may enjoy products that have fragrance, but you will have to switch them all to ones that are fragrance-free. This can be a real change for people, and often for everyone in the household too, since they’re going to have to change the soaps and moisturizers the family uses.

Another frustrating thing about AD is that sometimes, it’s really itchy and uncomfortable, but your skin looks normal. In dermatology, we sometimes call eczema “the itch that scratches.” It looks normal, but then it starts itching, so you scratch it, and then you get the rash or the typical appearance of eczema. Kids, especially, sometimes feel that their parents don’t believe them because the skin can look normal. Yet they get these sensations of itching and discomfort that may not show up as classic eczema for days to weeks after they get that sensation.

You’ll have changes to make after your diagnosis, too. Depending on how severe the eczema is, we give most of our patients prescriptions — medications to either put on your skin or take by mouth — to help calm down the inflammation.

But a big part of treatment involves changing your entire skin care routine. For example: Using specific moisturizers multiple times a day with ingredients like ceramide and hyaluronic acid. These ingredients trap water in the skin and repair that barrier.

You’ll need to use fragrance-free, gentle soaps and change your laundry detergents, fabric softeners, and fabric sheets to free and clear products. Everything that touches your skin will need to be changed to a simple, allergen-free product. For people with severe eczema, we recommend sticking with simple 100% cotton clothing because some of the polyester blends can actually irritate the skin.

You definitely have to be dedicated to stick with your treatment. You need to use your moisturizer after you shower and then use your prescription medications on the areas of eczema. All the changes can be a big challenge for some people or, at the very least, quite different from what you’re used to doing.

Misconceptions

There are a couple of mistaken beliefs when it comes to atopic dermatitis. The first is that it’s contagious. Kids at school might tease kids with eczema or say, “They have that rash; it’s contagious.” A married couple will say, “He has eczema. I don’t want to get it from him, so we sleep in separate beds.” We know that’s not the case. It’s just a defect in the skin barrier that makes it less able to trap water.

The other misconception is that people with eczema don’t have good hygiene — they’re not clean enough, or their skin is dirty — which is also not true. It doesn’t come up often, but we definitely do hear those two.

Education and Support

I think it’s important for people with AD to have a support group. There are some online resources for that. Education about the condition itself is crucial, too. I find that visual aids can help explain what it is and how it works.

It’s really important to teach people how to care for their skin to prevent flare-ups. Once it’s flared, we give them prescriptions, but what can they do to keep their skin healthy and prevent those flare-ups from happening? They need to be educated about the clothing they wear and the products they use, things that may not be as obvious as we think.

You Have Options

Trying all these new things can be very frustrating, so seek care from your dermatologist if you’re not sure what’s going on with your skin or your routine isn’t working. There are so many other conditions that can look like eczema that may or may not actually be eczema. Plus, there are a lot of new medications that are fantastic and can greatly improve your quality of life.

And don’t discount how much good skin care can actually help. Just following simple recommendations can go a long way in preventing flare-ups in the future.