Atopic Dermatitis-Eczema
Definition
Atopic Dermatitis, also known as Atopic Eczema, is a chronic, recurrent inflammatory skin condition that typically manifests in childhood and is often associated with allergic diseases such as asthma and rhinitis.
Although most children experience improvement before adulthood, the disease can persist into adult life. It presents with redness and intense itching of the skin, featuring periods of flare-ups and remissions.
Phototherapy is considered the most advanced, effective, and safe treatment for Atopic Dermatitis (Eczema).
• Natural and innovative therapy
• Soothing and healing action for the skin
• No side effects
Symptoms
Atopic dermatitis (eczema) presents with a wide range of symptoms that vary from person to person. The main symptoms include:
• Itching: Especially intense at night.
• Skin rashes: Red, brown, or gray patches, primarily on the hands, feet, neck, eyelids, and on the face in infants.
• Rough and dry skin
• Swelling: Sensitive skin from scratching.
Atopic dermatitis usually begins before the age of 5 and can continue through adolescence and adulthood, with flare-ups and remissions.
Infantile Eczema (2 months–2 years): Primarily appears on the cheeks and may spread to other areas. It often resolves by the end of the second year of life.
Childhood Atopic Dermatitis (2–12 years): Primarily affects the neck, arms, and legs. About 60% of cases improve by age 5, and 90% before adolescence.
Adolescent/Adult Atopic Dermatitis (12 years and older): Lesions typically appear on the extremities, such as the palms and soles, and may cause hyperpigmentation or hypopigmentation.
Causes
The exact causes of atopic dermatitis remain unclear, but it appears to result from a combination of factors such as impaired skin barrier function, immune/environmental factors, and genetic predisposition.
Patients often have colonization of Staphylococcus aureus bacteria on their skin, which can proliferate in wounds or lesions and worsen symptoms—especially in children.
Aggravating factors for atopic dermatitis include:
• Dry skin from prolonged hot showers or baths
• Itching that causes further damage
• Infections from bacteria and viruses
• Temperature and humidity fluctuations
• Chemical products like cleaners and soaps
• Woolen clothes and fabrics
• Dust and pollen
• Air pollution and cigarette smoke
• Stress and sweating
Additionally, in children and infants, food allergies (e.g., peanuts, soy, fish, eggs, milk, wheat) may be associated with atopic dermatitis.
Therapeutic Approach
Atopic Dermatitis requires long-term management. Patients may need to try various treatments over months or even years to control their symptoms. Early diagnosis is critical for timely therapeutic intervention.
Phototherapy
Phototherapy is a modern and safe treatment method for atopic dermatitis. It involves controlled exposure of the skin to natural sunlight or special LED lights that emit safe wavelengths. This therapy is clinically proven to be effective, with 70% of patients showing significant improvement.
✓ Reduces inflammation
✓ Restores skin microbiome
✓ Accelerates healing
✓ Prevents bacterial superinfections
✓ Relieves itching
The beneficial red and near-infrared light wavelengths boost immune function, reduce redness, and provide skin-rejuvenating effects.
This therapy is completely natural, painless, and free of side effects, making it ideal for all ages and skin types.
UV-free phototherapy stimulates the body’s natural defense mechanisms and restores skin health, with visible results in just a few weeks.
Pharmacological Approach
✓ Topical emollient creams: A cornerstone of treatment for atopic dermatitis. Daily use reduces the frequency and severity of relapses by keeping the skin hydrated and protected.
✓ Anti-itch and anti-inflammatory creams: Dermatologists may prescribe corticosteroid creams or ointments to relieve inflammation and itching. These treatments are effective for immediate symptom relief.
✓ Barrier-repair creams: Calcineurin inhibitors affect the immune system and can be used as maintenance therapy, offering a safe and effective treatment option.
✓ Antibiotics: If there is bacterial infection or open wounds caused by scratching, antibiotics may be necessary to combat the infection.
✓ Oral antipruritic medications: In cases of severe itching, antihistamines can help alleviate discomfort.
✓ Oral or injectable anti-inflammatory medications: For more severe cases, doctors may prescribe oral or injectable corticosteroids.Newer Treatment Options
IgG4 Monoclonal Antibody – targeting the IL4Rα receptor
Dupilumab (Dupixent)
Dupilumab is a recombinant IgG4 monoclonal antibody that targets the IL4Rα receptor, blocking the action of interleukins IL-4 and IL-13 responsible for type 2 inflammation that causes redness, itching, shortness of breath, and mucus production.
The drug is approved for the treatment of moderate to severe atopic dermatitis in adults and children aged 6 and older.Clinical studies on a large number of patients have shown that a significant proportion achieved a 75% improvement in clinical severity, with over 40% achieving clear or almost clear skin and sustained long-term remission.
Additionally, substantial reduction of itching was observed.
Dupilumab can be combined with topical treatments.
It is administered via subcutaneous injection every two weeks and has a relatively safe adverse event profile with rare drug interactions.
Common side effects include mild upper respiratory infections, joint pain, reversible eosinophilia, conjunctivitis, and mild injection-site reactions.JAK1 Inhibitors
Selective JAK1 inhibitors represent a newer oral treatment option for patients with moderate to severe atopic dermatitis that is not adequately controlled by topical agents or biologics.
They act by blocking the signaling of inflammatory cytokines such as IL‑4, IL‑13, and IL‑31, which are involved in persistent itching, inflammation, and skin barrier dysfunction.Their action provides rapid symptom relief within the first weeks of treatment, improving sleep, quality of life, and clinical indices such as EASI and NRS.
Upadacitinib (Rinvoq), abrocitinib (Cibinqo), and baricitinib (Olumiant) are approved for the treatment of atopic dermatitis in adults and adolescents aged 12 and over.
They are administered orally on a daily basis, with doses personalized based on disease severity and kidney function.JAK1 inhibitors offer faster onset of action compared to older therapies and have shown superior results in achieving high treatment targets such as EASI‑90 in several studies.
The most common side effects include nausea, headache, mild infections, and increases in lipids or CPK levels. Rare but serious adverse events include thromboembolic events and tuberculosis reactivation, requiring preventive screening and regular lab monitoring.
JAK1 inhibitors are a modern, effective, and well-tolerated systemic treatment for atopic dermatitis, particularly suitable for patients with extensive or resistant disease, especially when accompanied by severe itching that disrupts sleep and daily life.
At Optimum Dermatology, patients with atopic dermatitis can effectively manage the disease and significantly improve their quality of life.