How to Get Atopic Dermatitis Into Remission

Medically reviewed by Susan Bard, MD

Atopic dermatitis (AD), also called atopic eczema, is the most common form of eczema. It is an inflammatory skin condition that can cause symptoms such as itching, dryness, redness, scaling, swelling, and oozing or weeping.

AD affects up to 25% of children and 4%–7% of adults. About 85% of cases begin before 5 years of age. Up to 70% of children with AD go into clinical remission before they reach adolescence.

AD is a chronic condition that relapses and remits (goes into periods of remission). Symptoms can flare up, go away for a time, and flare up again. Approaches to treating AD typically include skin care routines such as bathing and moisturizing and topical corticosteroids. Sometimes, other medications or treatments are necessary.

This article will discuss what atopic dermatitis is, symptoms of AD, common triggers, home remedies for mild AD, treatment for severe and/or recurrent AD, and what to do during an AD flare.

Atopic Dermatitis: A Disease and Type of Eczema

AD is a type of eczema. Typically, when people refer to simply "eczema," they mean this form. It is a chronic, inflammatory skin condition caused by an interaction of factors such as:

• Genetics (epidermal gene mutations)

• Immune dysregulation (immune system not reacting as it should)

• Environmental factors

• Skin microbiome abnormalities (upsets in the natural balance of microbes that live on the skin)

• Impaired epidermal barrier integrity (gaps in the skin allow too much moisture to get out and can allow germs and irritants to get in, causing inflammation)

About 85% of AD cases begin before age 5, but it can begin in adulthood. About 25% of adults with AD report the onset occurring when they're adults. Most children outgrow AD by adulthood, but about 33% of childhood AD cases persist into adulthood.

Though there is no way to know whether the condition will go away or persist, the more severe the AD, the more likely it will continue into adulthood. Early diagnosis and proper treatment can help prevent the condition from worsening.

Often, adults who have outgrown AD still have skin that is easily irritated and may struggle with activities that involve regularly getting their hands wet.

AD is more common in people of African, Asian, and Pacific Islander descent. In the United States, Black children are estimated to be twice as likely as White children to develop AD.

AD can be the first step in the "atopic march" sequence of conditions. It is followed by conditions such as:

• Asthma

• Food allergy

• Allergic rhinoconjunctivitis (recurrent nose and eye problems)
  

Symptoms: What Atopic Dermatitis Looks Like

AD can occur anywhere on the body but often affects areas such as:

• Skin folds

• Head

• Face

• Neck

• Hands and wrists

• Feet and ankles

• Trunk
  

Age can affect where and how AD occurs. Babies and young toddlers often have raised, reddish patches or plaques on their face, scalp, trunk, and extremities. Older children typically get patches on the inside of joint creases, such as elbows and knees, and can have affected areas on the neck, hands, or feet.

Adults may have dry, scaly patches on the hands, eyelids, or genitals.

Symptoms can vary but may include:

• Itching (almost always, regardless of age), which may worsen at night and impair sleep
  

• Blisters with oozing and crusting

• Dry skin, possibly all over the body

• Areas of bumpy skin, such as on the back of the arms or front of the thighs

• Skin redness or inflammation (around blisters)

• Areas of raw skin from scratching

• Thickened ("leather-like") areas, especially after long-term irritation or scratching

• Ear discharge or bleeding
  

• Warm, sometimes swollen skin from inflammation
  

• Bumps or rashes that leak fluid

• Cracked skin

• Thickened, darker skin around the eyes (more common in adults)

• Healed skin that is darker or lighter where the AD was
  

AD can look different on different skin tones. AD on darker skin tones is more likely to present with small bumps, extremely dry skin, and dark brown, purple, or grayish areas where the AD is. AD on lighter skin tones is more likely to present with a red rash.

AD flare-ups may:

• Come and go for years

• Stop for a period, then start back up

• Occur in the same place over and over or change locations
  

Atopic Dermatitis Staging

AD can be categorized into three clinical phases:

• Acute: Vesicular (fluid-filled bumps), weeping, and crusting

• Subacute: Dry, scaly, reddish papules and plaques

• Chronic: Lichenification (thickened, leathery skin) from repeated scratching

It can also be categorized as:

• Persistent: AD at every follow-up until age 7

• Intermittent: Early AD that doesn't fit the criteria for persistent or remission

• Remission: No AD after 2 years old

Common Triggers

Triggers for AD flare-ups depend on the individual, but may include:

• Allergens, such as dust mites, pollen, molds, and animal dander

• Physical or emotional stress

• Sweating

• Changes in weather (hot and cold)

• Wool clothing and other rough materials

• Certain skin care products

• Perfumes and products that contain fragrances, such as laundry detergents

• Cold, dry winter air

• Contact with irritants or certain chemicals

• Dry skin

• Cold or flu illness

• Too frequent baths, showers, or swimming, leading to dried-out skin
  

Home Remedies for Mild Atopic Dermatitis

Home care for AD is essential whether or not medication is also necessary. People who have mild AD may find they can manage their condition with home remedies alone.

Education

Talk to your healthcare provider about how to care for your skin with AD. Learn how to look for and avoid things that trigger flare-ups or worsen your symptoms.

Bathing

Bathing once a day for five to 10 minutes in lukewarm water can help hydrate and cleanse the skin. It also helps to remove crusts, scales, allergens, bacteria, and irritants.

Make sure to use cleansers that are:

• Soap-free

• Dye-free

• Fragrance-free

After bathing, pat dry skin and apply emollients (moisturizers) within three minutes. This helps to seal in the moisture from bathing.

Moisturizing

Using emollients regularly and in liberal amounts is essential for preventing and treating AD flare-ups. They are important for both flare-up treatment and regular skin maintenance.

Look for emollients that:

• Have a high lipid (oil) and low water content (ointments have the highest oil ratio, then creams, followed by lotions)

• Are fragrance-free

• Are alcohol-free

There is no brand of over-the-counter (OTC) emollients that research has found superior. Go with what works for you. The same is true for how often to apply it. Generally, emollients are applied one to three times a day, but you can tailor this to your individual needs.

Prescription emollients are also available, but there doesn't appear to be a difference in effectiveness between OTC and prescription emollients. Talk to your healthcare provider if you feel prescription emollients may be right for you.

Diluted Bleach Baths

Diluted bleach baths can help reduce the number of Staphylococcus aureus infections (a type of staph skin infection) and reduce the need for systemic antibiotics in those who have skin that is heavily colonized with this bacteria.

The concentration of a diluted bleach bath is similar to the amount of chlorine in a swimming pool.

Talk to your healthcare provider before implementing diluted bleach baths and follow their directions. Diluted bleach baths may involve:

1. Filling a bathtub with lukewarm water

2. Thoroughly mixing in one-quarter cup to one-half cup (60–120 milliliters) of chlorine bleach

3. Soaking in the bath for about 10 minutes

4. Thoroughly rinsing your body with fresh water

5. Patting the skin dry

6. Immediately applying emollients

Your healthcare provider can tell you how often and for how long to take these baths, but one recommendation is twice weekly for a period of three months.

Wet Wrap Therapy

Healthcare providers sometimes recommend wet wrap therapy, but research into how effective they are and whether they have the potential for complications such as infections is conflicting. A systemic review found no quality evidence to show they are better than conventional topical therapies like corticosteroids.

Wet wrap therapy is typically recommended for people whose AD is difficult to manage, especially during flare-ups.

Wet wrap therapy may involve:

1. Soaking in warm water for about 15–20 minutes

2. Patting the skin dry

3. Applying topical medications and/or emollients on the areas affected by AD

4. Applying damp (not dripping) dressings (gauze or cotton clothing) on top of the affected areas

5. Covering the damp dressing with dry wrap material (such as elastic bandages, pajamas, or socks)

6. Leaving the wraps on for two to six hours (or overnight)

Avoiding Scratching

Scratching can make AD worse. In addition to treating AD, you can help discourage scratching and minimize damage from scratching by keeping fingernails short or wearing light gloves (especially during sleep).

Everyday Skincare

Having a daily skin care routine is essential for people who have AD, with daily bathing and generous application of moisturizers among two of the most important steps.

Other tips for caring for your skin include:

• Keep baths and showers short (five to 10 minutes) and always moisturize afterward.

• Choose products that say fragrance-free, not just unscented.

• Test new skin products on a small area every day for seven to 10 days before applying them all over to see if a reaction occurs.

• Wear loose-fitting (not tight) clothing.

• Choose 100% cotton clothing and never wear wool next to your skin.

• Wash new clothes before you wear them.

• Choose fragrance-free and dye-free laundry detergents.

• Remove tags from clothing, or choose ones without tags.

• Cover irritating clothing seams with silk.

• Protect your skin from extreme hot or cold temperatures.

Treating Severe, Recurrent Atopic Dermatitis

Depending on the severity of the AD and the age of the person, AD treatment may include prescription medications and/or other medical treatments.

• Topical corticosteroids: First-line treatment for AD flares

• Other topical anti-inflammatory medications: Including calcineurin inhibitors tacrolimus and pimecrolimus, topical phosphodiesterase-4 inhibitor Eucrisa (crisaborole) ointment, and topical Janus kinase (JAK) inhibitor ruxolitinib cream

• Systemic (whole body) medications: Including biologics Dupixent (dupilumab) and Adbry (tralokinumab-ldrm), and JAK inhibitors Cibinqo (abrocitinib) and Rinvoq (upadacitinib)

• Immunosuppressant medications: Including azathioprine, cyclosporine, methotrexate, and mycophenolate mofetil

• Oral antibiotic medications: Used to treat secondary skin infections

• Ultraviolet phototherapy: Light therapy, narrowband ultraviolet B, with or without oral psoralen
  

What to Do During an Atopic Dermatitis Flare

If you don't already have a treatment plan in place for AD flare-ups, talk to your healthcare provider. What works for some people doesn't work for others, and each plan should be individualized.

In addition to keeping up your skin care routine, your healthcare provider may recommend using topical corticosteroids. This is the typical first-line treatment for AD flare-ups. These medications can have side effects, so it's important to speak to your healthcare provider before using them and to follow their instructions for use.

Make sure to apply topical corticosteroids directly to the affected areas before applying emollients, not after. This helps the medication work effectively.

Summary

Atopic dermatitis is a chronic, inflammatory skin condition that causes symptoms such as itching, dry skin, and skin rash. AD is most common in childhood but can persist into or begin in adulthood.

AD can often be managed at home with measures such as avoiding triggers, daily bathing, moisturizing, avoiding scratching, and if necessary, diluted bleach baths. Wet wrap therapy may help some people with AD during a flare-up.

If AD is more severe or persistent, prescription medications and/or light therapy may be necessary. Treatment plans should be individualized. Talk to your healthcare provider to determine what is right for you.

Read the original article on Verywell Health.