Coping With Advanced Atopic Dermatitis

Advanced atopic dermatitis, commonly known as eczema, is a chronic condition that leads to itchiness, inflammation, redness, and flaking of the skin. Though it’s not contagious and the disease can be managed, unfortunately, there is no cure.

Typically arising during childhood, the condition is fairly common, with an estimated 12% of children and 7% of adults in the U.S. experiencing it. Symptoms of atopic dermatitis, which include reddish skin and the development of rashes, tend to come in waves between periods of calm.

This can exact a heavy toll on your emotional, physical, and social well-being, all of which are related to one another. Taking eczema on means attending to these aspects, while also becoming as knowledgeable as possible about the condition.

So what do you do if you’ve been diagnosed? A responsive approach to advanced atopic dermatitis combines medical treatments with home remedies and lifestyle changes to ease symptoms and flare-ups. It also involves attending to the broader personal and social impact of this chronic disease.   

Emotional

With any chronic condition, an emotional and psychological impact is expected, and this is certainly the case with atopic dermatitis. If you’re struggling emotionally because of this disease, remember that you’re far from alone.

In fact, about 1 in 5 people with the condition face major depressive disorder (clinical depression), and they’re more likely to experience anxiety and/or become suicidal.

Since the severity of these psychological issues is often closely tied to the severity of atopic dermatitis, managing the physical symptoms is a big part of taking them on. That said, there are some additional means of coping with the condition:

• Talk to your healthcare provider about challenging emotions you’re feeling, and especially if you experience feelings of sadness, anxiety, loss of energy or motivation, hopelessness, lack of concentration, and restlessness. They may be able to direct you toward professionals who can help.
• Therapy may be required to help you cope with this condition. Group sessions can be helpful, as they allow those who share the experience to speak openly and without the fear of stigma. Individual sessions with counselors or psychiatrists can also help.
• Regular exercise can improve emotional health. Current recommendations are that you aim for a minimum of 150 minutes a week of cardiovascular exercise. This equates to about 30 minutes a day, five days a week. Just be mindful if sweat triggers your atopic dermatitis.
• Emphasize good sleep, as this can be challenging with the condition. Poor sleep is linked with increased rates of depression, anxiety, and other issues. Choose a regular bedtime, take antihistamines before bed, apply medicated creams, and consider taking a relaxing bath beforehand.  
• Keep a journal to record your thoughts and feelings as you experience eczema. Not only does this help emotionally, but it also allows you to get a better sense of the scope of your condition and what sets it off.   
• Relaxation methods, such as meditation or yoga, have also been known to help with the emotional fallout related to eczema. These can help ease negative thoughts and improve the quality of sleep. Even simple, relaxing activities, such as reading a book, baking, or taking a daily walk, can help.

Physical

The biggest challenge in coping with atopic dermatitis involves taking on and easing the itchiness, irritation, redness, and scaliness of the skin associated with it. Notably, this disease goes through periods of activity (attacks) and periods where symptoms subside (remission).

In the absence of an outright cure, there’s actually a lot you can do:

• Prescribed medications: Your healthcare provider may prescribe ointments or medications that ease symptoms. Current options include steroid pills, creams, or shots. New classes of drugs, including injectable biologics such as Dupixent (dupilumab) and Adbry (tralokinumab-ldrm), and oral biologics like Cibinqo (abrocitinib) and Rinvoq (upadacitinib) are emerging to treat difficult cases.
• Over-the-counter (OTC) medications: Topical ointments containing steroids, such as Cortisone 10 (hydrocortisone) and Cort-Aid (hydrocortisone acetate), are available over the counter and can help with itching and redness. Antihistamine drugs such asClaritin (loratadine), among others, can also help.
• Moisturizing: Multiple times a day, and especially after bathing, you should moisturize affected areas. Don’t use lotions—you should apply ointments or creams instead. Petroleum jelly is an excellent choice.  
• Bathing: When bathing or washing, make sure to use mild, fragrance-free, and alcohol-free soaps. These are often labeled “hypoallergenic,” “fragrance-free,” or especially “for sensitive skin.” When bathing, opt for a warm rather than hot water temperature. Bath oils and even apple cider vinegar can also help.
• Dietary shifts: While healthcare providers are still unsure if diet can trigger attacks, allergic reactions to certain foods may play a part. Talk to your healthcare provider about allergy testing to see if this may be a factor in your case.
• Wet wrap therapy: More challenging cases can be taken on by first soaking in water for 10 to 15 minutes, patting the skin (especially affected areas) dry, then applying topical medicines. Areas are then wrapped in wet bandages or clothing, followed by a dry top layer of dressing. This is applied for two to six hours.
• Bleach baths: An approach known to help with symptoms is bathing in a mild solution of bleach and water. This helps not only reduce inflammation but can also kill bacteria on the skin and prevent infection. Add a half cup of bleach to warm bathwater and soak for 10 minutes.
• Phototherapy: The application of ultraviolet (UV) rays has been shown to help those with eczema and may be recommended by your healthcare provider. This is a prescribed approach and requires you to stand for short periods of time in a light-emitting device.

Social

With atopic dermatitis, there are more than just the physical symptoms and emotional challenges to face. Since this condition so dramatically affects the skin, people with it (especially those who are younger) may feel social stigma and embarrassment, impacting their quality of life.

What’s worse, people who have eczema may sense that their condition is impacting others. For example, parents of severely affected children may become more exhausted in dealing with the case, something that, in turn, impacts the person with the condition. This leads to a cycle of stigmatization.

So what can you do to help take on the social impact of atopic dermatitis? Here are some quick tips:

• Seek group support: Working with others impacted by the condition can greatly help combat the associated stigma. Talk to your healthcare provider to see if they know of any helpful groups. Advocacy groups like the National Eczema Association also organize groups and provide helpful information.
• Find help online: More informal groups of people with eczema or those with family members with the condition have also arisen on social media. It’s worth searching around Facebook, or your preferred website, to see about connecting with others online.
• Communicate clearly: Talk to loved ones, family, and friends about your condition, and try to be open about how you feel. Most people with atopic dermatitis feel better being open about their condition rather than coping with this burden on their own.    

Practical

Given that stigma can surround advanced atopic dermatitis, it stands to reason that the condition can affect how you’re perceived at work and in the home. Roommates, coworkers, or family members—if made aware of your case—may develop conscious or subconscious resentment as they feel a need to accommodate your condition.

At work, it’s a good idea to see what can be done to ease the condition's impact. You may want to have extra ointments or medicines handy to help with flare-ups, especially because workplaces may be rife with potential triggers. Talk to your manager or human resources department if you feel you need any accommodations.

With housework, be sure that you are protecting yourself and your skin. Wear gloves to protect your hands when washing dishes or doing cleaning and protect your skin when gardening. Talk with family members or roommates so they understand your condition and what you’re going through.