When you have atopic dermatitis (AD), your goal is to relieve dry, itchy skin and feel more like yourself again. But managing eczema can be challenging. It's easy to get stuck in the itch-scratch cycle. Your skin itches, so you scratch it. Scratching damages your skin, which makes you itch even more. But there are ways to escape from this cycle.
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Atopic dermatitis, also known as eczema, happens because of damage to your skin's protective barrier. Moisture leaks out of your skin and allergens sneak in, causing symptoms like:
Managing this skin condition starts by identifying and avoiding your triggers, managing flare-ups with your doctor's help, and caring for your skin along with the rest of you.
Triggers of AD
Genetic changes, age, and certain medical conditions that weaken your skin's barrier set you up for AD. Then something in your environment triggers flare-ups. Everyone's triggers are different. Learning yours can help you avoid them and prevent symptom flares.
Some of the most common AD triggers are:
Skin care and laundry products that contain fragrances and dyes
Allergens like dust, ragweed, and pet dander
Scratchy fabrics like wool or synthetic fabrics such as acrylic
Extreme heat and cold
Humidity
Sweat
Stress
Skin care and laundry products that contain fragrances and dyes
Allergens like dust, ragweed, and pet dander
Scratchy fabrics like wool or synthetic fabrics such as acrylic
Extreme heat and cold
Humidity
Sweat
Stress
Skin care and laundry products that contain fragrances and dyes
Allergens like dust, ragweed, and pet dander
Scratchy fabrics like wool or synthetic fabrics such as acrylic
Extreme heat and cold
Humidity
Sweat
Stress
Other triggers aren't as well known, but they can still set off symptoms:
Viruses like colds or herpes
Extreme temperature changes
Air pollution
Hair dye
Hard water
A lack of sun exposure
Viruses like colds or herpes
Extreme temperature changes
Air pollution
Hair dye
Hard water
A lack of sun exposure
Viruses like colds or herpes
Extreme temperature changes
Air pollution
Extreme heat and cold
Hair dye
Hard water
A lack of sun exposure
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Daily Care for AD
Managing AD should be part of your daily routine, just like brushing your teeth and showering. The average day with AD could look something like this:
Morning
Morning
Bathing once or even twice a day is good when you've got eczema. A shower or bath helps to replace moisture your leaky skin barrier lets out. You can bathe in the morning, at night, or both.
Shower or bathe in lukewarm water for no more than 10 to 15 minutes. Wash your skin with a gentle fragrance- and dye-free cleanser. Don't scrub, because it could irritate your skin.
Rub on a prescription or over-the-counter medicated cream or moisturizer while your skin is still damp, to lock in moisture.
Put on loose clothes made from breathable and sweat-absorbing fabrics like cotton, silk, or bamboo.
During the day
During
the day
While a little bit of sun exposure sometimes improves AD symptoms, a sunburn could make them worse. If you're headed outdoors, protect your skin.
Apply a broad-spectrum, UVA and UVB, fragrance-free sunscreen with a sun protection factor (SPF) of 30 or higher. Test out the sunscreen on a small area of skin before you use it, to make sure you're not sensitive to the ingredients.
Try to avoid AD triggers like:
- Humid weather
- Perfumes and dyes
- Pet dander
- Pollen
- Dust
- Insect bites
- Stress
At night
At night
During the winter months when the air is dry, turn on a humidifier or vaporizer before bed to add moisture to the air. Keep your bedroom cool between 60 and 65 degrees Fahrenheit so you won't overheat.
And itchiness can disrupt your sleep. Apply a thick emollient or ointment to itchy areas of skin before bedtime. Then wrap the skin in moist bandages. Not only will the wet wrap seal in moisture, but it will also form a barrier that stops you from scratching while you sleep.
Wear pajamas in soft, natural fabrics to bed. You might also wear cotton gloves to prevent you from scratching.
If nighttime itching continues to be a problem, ask your doctor about bleach baths, topical steroids, and other AD treatments to help control the itch.
Medical Treatments for AD
Talk to your doctor about your treatment plan and what medicines will work best to manage your symptoms. Medical treatment for AD can include topical medicines, anti-inflammatory pills, and injectable medicines. The goal is to relieve symptoms and give your skin a chance to heal.
Topicals
Topical treatments reduce inflammation and itching. They also may play an important role in helping maintain healthy skin. You rub these prescription medicines on your skin once or twice a day:
- Corticosteroid cream or ointment
- Calcineurin inhibitors pimecrolimus cream (Elidel) and tacrolimus ointment (Protopic)
- PDE4 inhibitor crisaborole ointment (Eucrisa)
- Roflumilast cream (Zoryve)
- Ruxolitinib cream (Opzelura)
- Tapinarof cream (Vtama)
Oral medications
These medicines work throughout your body to calm your overactive immune system and reduce inflammation.
Oral Janus kinase (JAK) inhibitors are for moderate to severe AD when other treatments haven't helped. Abrocitinib (Cibinqo), and upadacitinib (Rinvoq) come as a pill that you take once a day.
These other oral immune-suppressing drugs may be an option if you can't take a JAK inhibitor or biologic drug:
- Azathioprine
- Cyclosporine
- Methotrexate
- Mycophenolate mofetil
Injectable medications
Biologic drugs block specific immune system proteins to reduce inflammation. If you have moderate to severe AD, these medicines, which come as shots, may help you get clearer skin and relieve itching:
- Dupilumab (Dupixent)
- Lebrikizumab-lbkz (Ebglyss)
- Nemolizumab-ilto (Nemluvio)
- Tralokinumab-ldrm (Adbry)
Adjust your bathing routine
Take a bath or shower once a day (or more often) to rinse off allergens and other irritants that trigger your symptoms. Wash with lukewarm water and a gentle, fragrance-free cleanser, then pat your skin dry. Apply cream within four minutes after you get out of the shower or bath to seal in moisture. Soaking in a colloidal oatmeal bath is another way to soothe itchy skin.
Wear itch-free clothing
Choose soft, breathable fabrics like cotton or bamboo. Use a gentle detergent to soften fabrics even more.
Eliminate food triggers
Some people find that certain foods flare up their AD. Common food triggers you may need to avoid if they bother you are:
- Peanuts and other nuts
- Eggs
- Milk
- Soy
- Wheat
- Fish and shellfish
Get enough sleep
You need sleep to recharge your body, but it can be hard to rest when you're itchy. To control the itch, take a warm bath or shower and rub on a moisturizer before bed. Keep your bedroom cool. If you still can't get enough rest, ask your doctor about taking an antihistamine at bedtime to help you sleep.
Battling
the Urge
to Scratch
Managing Mental Health Challenges of AD
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Living with a chronic, uncomfortable, and visible disease like AD can have a negative effect on your emotional well-being. AD causes stress and anxiety. Stress and anxiety cause more symptom flare-ups. And the cycle continues.
Caring for your mental health is just as important as caring for your skin.
Atopic
Dermatitis:
More Than
Skin Deep
Watch for these signs that you might be depressed:
- You feel sad or anxious.
- You have no energy or interest in doing things you once enjoyed.
- You can't sleep.
- You feel tired all the time.
- You've gained or lost weight.
- You'd rather be alone than with loved ones.
- You've thought about hurting yourself.
What you can do
Start by talking to your doctor or a mental health care provider. Try relaxation techniques like yoga, meditation, or tai chi. Join an eczema support group. You can find one of these groups through an organization like the National Eczema Association.
Learn More About Atopic Dermatitis
