Atopic dermatitis

Last updated on: 20 April 2020 | Released on: 8 November 2019

Q1
I have been using steroid topical medication or tacrolimus topical medication, but the symptoms have not improved and I’m worried about the side effects. What should I do?
A1
Some people whose symptoms do not improve are not applying enough medicine, especially the amount used in a single application. With steroid topical medications, it is important to know how much to use in a single application and to make sure this is how much you apply. Furthermore, inflammation may remain in the deeper layers of your skin even though visible symptoms have subsided. With tacrolimus topical medications, some people experience a strong irritation or itchiness after commencing use, and the condition of the skin may deteriorate. When starting to use such medications, you may need to improvise and, for example, use only tiny amounts at first. If you are concerned about side effects and take the decision on your own to reduce the amount you use or to stop using the medicine, you may excessively exacerbate your symptoms. There is also the possibility that the severity of your symptoms and the type of medication (strength) do not match, and your symptoms may be exacerbated by the way you apply the medication and whether moisturization is appropriate among other factors, so please consult your doctor again.
Q2
Why do I have to keep using steroid topical medication even though my symptoms have improved after I started using it?
A2
Atopic dermatitis will continuously deteriorate and last for a long time unless inflammation in the skin is suppressed as soon as possible. You should continue to apply the medication for as long as your doctor tells you to although symptoms may temporarily improve after the application of steroid topical medication and the surface of your skin may appear to be fine, in many cases inflammation remains inside the skin. If you take the decision on your own to reduce the amount you use or to stop using the medicine, your symptoms may once again be exacerbated.
Q3
Do children who have atopic dermatitis require dietary therapy?
A3
If you suspect that food is related to the problem, always be sure to speak to a doctor who is well versed in food allergies or to a specialist. Food allergens may be a factor in atopic dermatitis during infancy and childhood, but in such cases symptoms will not improve just through dietary therapy.
If symptoms deteriorate, other factors may be involved such as insufficient skin care and moisturization, inappropriate medicinal therapy, and environmental factors such as house dust. Before starting dietary therapy, it is important to first obtain a correct diagnosis by an appropriate doctor and to minimize the foods removed from the diet.
Q4
In which order should I apply moisturizer and topical medicine? Also, what should I do if I also want to apply sunscreen or other such creams?
A4
If the order of application is not noted on the prescription and your doctor has not given any instructions, you can consider that it is OK to start with the medication that must be applied over the greatest area first. Generally, first wash and clean your body, and then apply in the order of (1) moisturizer then (2) steroid or other topical medication. If you then wish to use sunscreen, insect repellant or other such products, first check that your skin is not irritated and then be sure to thoroughly remove it after use. If you wish to use all of these, the order of application is (1) moisturizer (2) topical medication (3) sunscreen and (4) insect repellent.
Q5
Is it OK to put clothes on immediately after applying a topical medication?
A5
Yes, you can put clothes on without problems immediately after applying the medicine. Parts of the skin that are in bad condition due to eczema or other such issues absorb medicine fast, so you can apply it thoroughly without having to worry about it getting on your clothes.
Q6
What kind of soap and shampoo should I use?
A6
You can use normal soap and shampoo with the same weak acidity as the skin without anything added to it. There is no particular need to purchase commercially available products that are sold as being specialized for atopic dermatitis, and you can use either solid or liquid soap. It is important to work up a lather, so be sure to do so and use a product that suits your skin. Also, if you don’t wash the soap off completely then this can cause rough skin, so be sure to wash all soap from your skin.
Q7
Is it true that stress causes the symptoms to get worse?
A7
In some cases of pubescent or adult atopic dermatitis, symptoms can be related to deterioration in psychological stress symptoms resulting from interpersonal relationships at school or work or home, being busy, concerns over future direction and becoming independent, or other such things.
If you feel worried or frustrated then you might scratch your skin unconsciously. This might become a habit and it can make it hard for your skin to heal. You have to know, among other things, what factors cause your symptoms to worsen and in what kind of situations you tend to scratch your skin.
Q8
What concrete action should I take when I start to sweat?
A8
If you sweat while displaying symptoms of eczema or inflammation on your skin and then take no action, this can cause your skin to become irritated and your symptoms to worsen. As such, you need to take measures against sweating. If you sweat, be sure to carefully and persistently wipe it away or wash it away in the shower or the like. In order to wash away sweat or dirt, it is considered effective to take a shower or a bath twice daily. It might be good to increase the number of showers or baths you have if you do exercise and in hot periods of the year. Also, after bathing the oil is washed from your skin and this makes it easy for your skin to dry out, so please be sure to moisturize. If you leave sweat to dry on your skin then it can worsen your symptoms, but as eczema improves you start to sweat so there is no need to detest the fact that you are sweating. Sweating a lot is proof that your condition has improved.
Q9
How should I deal with people who are reluctant to use steroids?
A9
Atopic dermatitis causes visible symptoms on the skin, and so there are many cases where people compare themselves to others and feel inferior. People who have concerns about steroid topical medication or refuse to use medicines have in some cases had a bad experience and lacked the opportunity to gain the correct knowledge or learn how to deal with their condition, and may believe incorrect word of mouth information that is not backed up by any scientific evidence or have been overwhelmed by information from the mass media or internet, and so are no longer able to trust medicine or doctors.
It is necessary to understand that in many cases they have battled with their condition and symptoms over a long period of time, and have experienced a range of conflicts and emotions. Rather than starting off by viewing the person as someone who lacks motivation and understanding and trying to convince them to do things the right way while they still feel rejected or opposed to it, first you need to deal with them by showing a willingness to listen to their feelings and why they feel worried about medicine and don’t want it. In the course of this communication, it is sometimes possible to find a starting point for a solution.
It may take a while to build up a trusting relationship, but you should try to come up with ideas that do not involve criticizing the person, such as handing over a guide to a talk being given by a specialist doctor or a leaflet on atopic dermatitis by a public institution without making a big thing of it for information provision purposes only (without trying to force the person to change their behavior), or depending on the situation consult an institution that can provide specialist consultations.
Q10
What should I do if I can’t sleep due to itching?
A10
You can cool the itching area and distract yourself. The feeling of cold suppresses the activity of nerves that cause itching, so in many cases cooling down an itching area reduces symptoms more than heating it. Try using a cold towel or an ice pack wrapped in soft cloth on the itching area, adjusting room temperature, and taking other such actions. Also, when someone is doing something they enjoy or they are concentrating on something else, they tend to scratch less. If you scratch at night then you concentrate only on this, so one method to deal with this is getting up for a while and doing something such as reading a book to take your mind off the itching.
If symptoms get obviously worse due to a lack of sleep, your treatment and care may not suit your current condition. In this case, consult your doctor to rethink the causes and your overall lifestyle together, and talk about treatment and measures to take.