Atopic Dermatitis: Diagnosis and Treatment

Diagnosis

• A medical history and physical examination are the primary diagnostic tools.
• There are no laboratory tests that can definitively diagnose atopic dermatitis. Skin allergy testing may be useful, but is not required to make the diagnosis.

Treatment

• Initial treatment involves eliminating factors that may worsen the disorder, such as soaps and detergents, food allergens, and cosmetics.
• Excessive bathing or use of lotions is discouraged, because evaporation of water from the skin worsens the disease. Many people are surprised to learn that water–based lotions actually increase evaporation of water from the skin, unlike emollient creams or ointments. Emollient creams or ointments should be applied liberally, especially after bathing, to lock in moisture. Humidifiers may be tried in dry climates.
• Antihistamines, such as diphenhydramine (Benadryl) or loratadine (Claritin) may relieve itching.
• Topical steroids may be used to treat active disease. Occasional use of topical steroids between episodes reduces the likelihood of recurrence. When severe flare–ups occur, oral steroids (e.g., prednisone) may be useful.
• Other medications, such as tacrolimus and cyclosporine, are sometimes prescribed for severe cases. However, these should be used carefully due to the risk of side effects, which may include skin cancer.
• Phototherapy using ultraviolet light is usually effective for treating severe disease, but may raise the risk for melanoma and other skin cancers.