Treating Atopic Dermatitis: Assessing the Severity
If you’re experiencing redness, discoloration, dryness, and itching from atopic dermatitis (AD), you may be seeking solutions from your dermatologist. Your doctor will first assess your symptoms.
„The first thing is to assess the severity of the condition,“ says Lindsay Strowd, MD, Associate Professor of Dermatology and Deputy Chairman of the Department of Dermatology at Wake Forest Baptist Health.
Doctors determine the severity of your Alzheimer’s disease by assessing the affected body surface area. The more areas of inflamed skin you have, the more severe your condition is. They also examine the location of AD on your body. Additionally, severe AD tends to have a deeper red color, but in some people with darker skin, the skin may appear discolored rather than red. It may even become lighter in color after the acute inflammation subsides. Your skin may also be thicker than normal and crack when you scratch it.
Another sign that you may need more intensive treatment is when topical medications have not brought the redness, discoloration, and itching under control. AD itching can be so severe that it affects your sleep and work. Your doctor will ask you about the intensity of your itching and how AD affects your daily life. „These components will guide our treatment decisions,“ says Strowd.
Creams and Phototherapy
Topical treatment may suffice to treat a mild case of AD. Coal tar has been used for over 100 years to treat AD and other skin conditions. Steroid creams help control itching and give your skin a chance to heal. Calcineurin inhibitors such as pimecrolimus (Elidel) and tacrolimus (Protopic) reduce the immune response to alleviate inflammation in your skin.
A newer type of topical treatment is crisaborole (Eucrisa). This ointment relieves inflammation, itching, and rashes in people aged 2 and older.
A group of new medications called Janus kinase (JAK) inhibitors has been approved for AD. They block a pathway that leads to the release of pro-inflammatory chemicals in the body. Ruxolitinib (Opzelura) is available as a cream.
Phototherapy, also known as light therapy, is an option if you have large areas of AD on your body. Your dermatologist may also recommend this treatment for patches in places like your hands and feet that do not improve with topical treatments. Phototherapy uses ultraviolet (UV) light to cleanse the skin.
If you suffer from severe Alzheimer’s disease or your skin does not improve through these treatments, it may be time to consider more comprehensive or advanced therapies.
Systemic medications work throughout the body and treat larger areas of Alzheimer’s disease. Dermatologists use some medications off-label, meaning they are approved for the treatment of other diseases but also work for AD.
A bodywide treatment is cyclosporine, which suppresses the overactive immune system reaction. „This is a very effective medication that reduces inflammation in the skin,“ says Jon Hanifin, MD, Professor Emeritus of Dermatology at the Oregon Health and Science University School of Medicine.
Other medications that work in a similar way include:
- Azathioprine (Azasan, Imuran)
- Methotrexate (Rheumatrex, Trexall)
- Mycophenolate mofetil (CellCept)
A downside of these treatments is that they can have serious side effects, including:
- Kidney or liver damage
- High blood pressure
- Muscle pain
- Electrolyte imbalances
Newer Options for Treating Moderate to Severe AD
In 2017, the FDA approved the first biological drug for AD, Dupilumab (Dupixent). It treats moderate to severe AD in adults and children aged 6 and older.
Dupixent is administered as an injection under the skin every two weeks. It blocks two proteins that cause inflammation in AD: interleukin-4 (IL-4) and interleukin-13 (IL-13).
„If you think the skin is on fire, a medication like methotrexate or prednisone [a steroid] acts like a fire blanket. ‚It smothers the fire,'“ says Strowd. „While a medication like Dupixent is like taking a fire extinguisher and shooting it on the fire. It’s a much more specific target.“
Studies have shown that Dupixent cleared the skin, relieved itching, and improved the quality of life in people with AD. More than half of those who took it for 16 weeks reported having 75% fewer symptoms. These improvements are long-lasting.
Dupixent is also safe, with the most common side effects being mild, including:
- Skin reactions at the injection site
- Cold sores on the mouth or lips
- Redness, swelling, and itching of the eyes and eyelids
A downside of Dupixent is the cost, which is over $3,200 per shot. The actual amount you pay depends on the type of your health insurance. Your insurance company may want you to try cheaper medications first before covering the cost of Dupixent, says Hanifin.
Another biologic, Tralokinumab-ldrm (Adbry), was approved by the FDA in December 2021 for adults aged 17 and older. It is also an interleukin inhibitor that blocks IL-13. You take it as a shot every two weeks. The side effects are similar to those of Dupixent. The costs are also similar, so you’ll need to check with your insurance coverage to determine if it’s covered for you.
Some JAK inhibitors can be taken as pills, which could be advantageous if you don’t like needles. These include the medications Abrocitinib (Cibinqo) and Upadacitinib (Rinvoq).
New treatments like Dupixent have improved the outlook for people with AD. They have allowed many people with this condition to have clear or nearly clear skin.
„It absolutely changes people’s lives if they have suffered,“ says Strowd. „It’s a very rewarding part of treating this disease in our modern times.“