Efficacy and safety considerations in topical treatments for atopic dermatitis.

As no cure exists for atopic dermatitis, the goals of treatment include reducing symptoms and prolonging periods between flares. Proper skin care can improve skin barrier function, reducing susceptibility to triggers of flares. Topical corticosteroids and topical calcineurin inhibitors may improve symptoms.

Efficacy of Nonprescription Moisturizers for Atopic Dermatitis: An Updated Review of Clinical Evidence.

Twice-daily moisturization is recommended by international guidelines as the bedrock of the management of atopic dermatitis (AD). Moisturizers should be selected based on proven clinical effectiveness in improving the skin barrier and improving the symptoms of AD. We searched the PubMed database for clinical trials assessing daily moisturization for the treatment of AD published between 2006 and 2019. Studies had to assess the efficacy of commercially available moisturizers using objective measures of corneometry, transepidermal water loss, or incidence of flare as endpoints, and treatments had to be currently available to patients. Clinical studies showed that moisturization (typically twice daily) significantly improved the skin barrier in adults and children with AD. Longer-term flare studies showed that daily moisturization reduced the incidence of flares and extended the time between flares. Proactive moisturization of infants at high risk of developing AD may reduce its manifestation. Therapeutic moisturizers for AD are specifically formulated with ingredients that target symptoms of AD, such as itch, inflammation, or compromised skin barrier. The US FDA requires that any moisturizer available in the USA and claiming to treat AD must contain colloidal oatmeal. Healthcare providers can maximize compliance and outcomes by educating patients on the benefits of liberally applying a therapeutic moisturizer twice daily to support the skin barrier and help reduce the incidence of flares. Specific recommendations should be for clinically tested moisturizers evaluated using objective, validated skin assessments.

Successful strategies in atopic dermatitis management.

Successful strategies for managing atopic dermatitis require an accurate diagnosis, identification and elimination of exacerbating factors including irritants and allergens, adequate hydration of the skin, control of pruritus and infections, and appropriate use of topical anti-inflammatory and other medications. Proper patient education increases the chances of successful therapy.

Wet Wrap Therapy in Moderate to Severe Atopic Dermatitis.

National and international guidelines address stepwise atopic dermatitis (AD) management. Wet wrap therapy (WWT) is important as an acute therapeutic intervention for treatment of moderate to severe AD. Using clothing instead of bandages makes this intervention simpler, less time intensive, and less expensive. Education of patients and caregivers is critical to success; methodology must be standardized. Future studies must carefully describe all procedure components. Incorporation of validated outcomes tools would help with interpretation. WWT should be considered as a potential treatment option ahead of systemic immunosuppressive therapies for patients failing conventional therapy.

Use of moisturizers in dermatologic disease: the role of healthcare providers in optimizing treatment outcomes.

Although atopic dermatitis is a common cutaneous disorder, patients often are frustrated in their attempts to understand the disease and its treatment. Studies have shown that the patient-provider relationship is key to patient compliance with a skin care regimen and that most patients with atopic dermatitis are eager to be well informed. However, many patients fail to receive an adequate explanation of the causes of atopic dermatitis or to be taught how to apply topical treatments, even though instruction and practical demonstrations are associated with a dramatic improvement in the treatment outcome. Efforts to educate patients regarding the use of moisturizers are correlated with clinical improvement and a reduction in the use of topical medications such as corticosteroids and calcineurin inhibitors. In addition to topical moisturizers, medications, wet wraps, and hydration therapy has become a frequently used practice in the management of atopic dermatitis.

Wet wrap therapy in children with moderate to severe atopic dermatitis in a multidisciplinary treatment program.

BACKGROUND: Atopic dermatitis (AD) is the most common chronic, relapsing inflammatory skin disease of children and is a global public health problem. National and international AD guidelines address AD care in a stepwise fashion. Wet wrap therapy (WWT) is a therapeutic intervention for moderate-to-severe AD. OBJECTIVE: This cohort study evaluated the effectiveness of WWT as part of a multidisciplinary AD treatment program to improve disease severity. Patients treated in this unique outpatient program had moderate-to-severe AD and had multiple therapies that failed. METHODS: An observational cohort study was completed. The primary outcome was improvement in AD severity as measured by SCORAD (Scoring Atopic Dermatitis). Demographics; clinical management of AD, including use of antibiotics and systemic treatments; and WWT methodology were comprehensively described. RESULTS: Seventy-two children with a mean ± SD age of 4.6 ± 3.12 years were included. By using a paired t test, the SCORAD at admission and at discharge showed significant differences in mean ± SD values, of 49.68 ± 17.72 versus 14.83 ± 7.45, respectively (t, 18.93; df, 71; P < .001). None of these patients required systemic immunosuppressive therapy during the treatment program. By using a previously published parent-administered outcomes tool, patients were shown to maintain clinical improvement of their AD 1 month after discharge. CONCLUSION: To our knowledge, this study is the largest to date of WWT for pediatric patients with moderate-to-severe AD by using a validated outcomes tool. None of the patients required systemic immunosuppressive therapy, and only 31% were treated with an oral antibiotic. This study demonstrated the benefit of incorporating WWT as an acute intervention in a supervised multidisciplinary AD treatment program with lasting benefit 1 month after discontinuing this intervention.

The role of the nurse educator in managing atopic dermatitis.

Nursing is making a key contribution to the development and evaluation of atopic dermatitis (AD) education. Educational interventions have long been recommended and used as a critical adjunct at all levels of therapy for patients with AD to enhance therapy effectiveness. These interventions may be directed toward adult patients or the parent/caregiver or child with eczema. Education should be individualized and includes teaching about the chronic or relapsing nature of AD, exacerbating factors, and therapeutic options with benefits, risks, and realistic expectations. This important educational facet of care management is becoming increasingly difficult to accomplish in routine care visits and seems to be equally difficult to measure and evaluate. A limited number of studies to date suggest effectiveness of educational approaches to improve the management of AD. We recommend that an international priority be given to assessing the effects of patient and parental education by nurses and other care providers in AD management using research studies designed to address the common weaknesses of existing randomized studies and the relative benefits of different strategies.