Atopic dermatitis treatments

The use of emollients in the management of atopic dermatitis is pivotal. They should be applied several times a day, and systematic use has been shown to reduce the need for corticosteroid creams. The main reason for intensive use of an emollient is its ability to increase hydration in the epidermis, mainly by reducing evaporation, as it acts as an occlusive layer on the top of the skin. As such, emollients have no direct effect on the course of the eczema. However, the appearance of the skin is enhanced, and itching is reduced.

The choice of emollient depends on the individual patient. It is generally recommended that a thick cream or ointment (with a high fat content) be used for the driest skin, whereas creams and lotions with a higher water content should only be used for very mild eczema. Such creams must be applied several times a day because of their rapid absorption into the skin. It is important to recommend an emollient without perfume or other potential allergens as they may provoke secondary allergic sensitization. Those with chronic, dry eczema benefit from tar preparations in the form of creams and occlusive bandages.

Bathing or showering daily, for about 5–10 minutes, may hydrate the skin and remove scales, crusting, irritants and allergens, which may be useful for patients with AD. However, letting water evaporate from the skin will cause a higher loss of transepidermal water, so it is recommended to apply moisturizers shortly after bathing or showering to keep the skin well hydrated.

If any area of the skin is significantly swollen, it is recommended to soak it in running water for 20 minutes, and then immediately apply an anti-inflammatory pharmacological treatment, such a TC, without drying it with a towel. This technique is called "soak and seal", and it may improve the response in cases where only applying a topical anti-inflammatory is not appropriate.

Wet wrap therapy (WWT) is a method to quickly reduce the severity of atopic dermatitis, and it is usually used, both in ambulatory or hospitalized patients, for significant outbreaks of the disease. In general, the technique consists of applying a topical agent and covering it firstly with a moist layer of tubular bandage or gauze, or a cotton bodysuit, followed by a second dry outer layer. When the condition is generalized, two layers of non-irritant clothes may be applied similarly. Wet wrap therapy seems to help with occlusion of the topical agent to increase penetration, reduce water loss, and provide a physical barrier against scratching. 

The wrap may be used from several hours to up to 24 hours, depending on the patient's tolerance. In general, it is suggested to use it for several days, although some studies regarding this technique continued it for up to two weeks.

As most patients affected by AD improve during the sunny summer season, artificial UV radiation is frequently employed in the treatment of atopic dermatitis. Phototherapy can improve and even clear atopic dermatitis; it can decrease bacterial colonization and reduce the strength and/or the amount of topical anti-inflammatory drugs needed, but the beneficial effects vary from person to person.