Understanding Your Treatment Options for Atopic Dermatitis

This article is for people who have eczema or atopic dermatitis (AD), or anyone who wants to learn more about eczema or AD. The goal of this patient education activity is to make patients feel confident about discussing treatment options for AD with their doctor.

You will learn:

• The difference between eczema and AD

• The difference between topical and systemic treatment

• What a biologic medicine is and how it works

• Other treatments for AD (like wet wraps and phototherapy)

• How to create a treatment plan with your doctor

• Questions to ask your doctor

Eczema refers to a general group of skin conditions that include rashes. AD is a type of eczema, and includes a dry, scaly, red rash that itches. It usually appears on cheeks, arms, and legs. Sometimes the rash will bleed or "weep" if scratched hard enough.

AD is a lifelong (chronic) condition. The rash may go away for a long time, even for years, and then flare up again. There is no cure for AD, but there is treatment for relief of your symptoms.

Yes. Because AD is caused by an overactive immune system reaction and a poorly working skin barrier, there are a number of different types of medicines available.

Medicines include gels or creams that you rub on your skin (topical treatment), as well as pills or shots (systemic treatment).

Some medicines work better than others, some provide temporary relief of symptoms, and some provide longer-lasting relief.

There may be other treatments that your doctor will recommend, depending on how long you have had AD or how severe your symptoms are.

Topical treatments can help manage the symptoms of AD and reduce inflammation. There are a few different types of topical treatment.

Topical steroids have been the mainstay of treatment for AD for decades. They can reduce itching and inflammation, and are available in many forms (ointment, gel, cream, and/or foam).

Topical immunosuppressants work to stop the immune reaction that causes AD, and include:

• Crisaborole (Eucrisa®): this ointment helps to reduce itching and redness, thickened skin, weepy rash, and raw, scratched lesions

• Tacrolimus (Protopic®): this ointment helps prevent redness and itch

• Pimecrolimus (Elidel®): this cream helps prevent redness and itch

There are different types of systemic treatments your doctor may recommend depending on whether your condition is mild, moderate, or severe, or if you are being treated for a severe flare-up.

Systemic steroids are used generally for short-term treatment for severe flares rather than long-term treatment.

Your doctor may also recommend a systemic immunosuppressant, which is used for other conditions, like rheumatoid arthritis or organ transplantation. It can reduce itching and chance of skin infection.

A new type of systemic treatment for AD is a biologic.

A biologic is a systemic medicine created from proteins and DNA rather than a combination of chemicals. It targets how your immune system reacts to inflammatory conditions, like AD, and can reduce your symptoms.

Dupilumab (Dupixent®) is the only biologic that is FDA-approved for the treatment of AD in patients 12 years and older. It's for people who haven't had improvement with topical treatments or can't use topical treatments.

It is given in a shot using a single-dose prefilled syringe once every other week. Your doctor will show you how to give yourself the shot and explain how to store it (refrigeration is needed).

You can identify what triggers your AD. A trigger is something that can cause your AD to flare up, and can be different for everyone. Once a trigger is identified, you can avoid it. Some triggers include:

• Types of fabrics

• Sun exposure

• Cosmetics, laundry detergents or fabric softeners, or certain skin products

• Environmental and food allergies

There are also many over-the-counter emollients (something that softens the skin) and moisturizers available at your local pharmacy that may help.

Your doctor may also recommend wet wrap therapy or phototherapy.

A wet wrap is a way to get moisture into your skin, since AD is a dry rash. After bathing, moisturizing, and applying a topical treatment, you will:

• Wrap damp gauze/cotton around the rash area

• Wrap a second layer of dry gauze/cotton around the wet layer (can also use pajamas, tube socks or whatever type of clothing would be an appropriate outer layer for the body area that you need to cover)

• Leave on for a few hours to up to 24 hours at a time

Wet wraps are generally used at night before bedtime. They can be used as treatment for flare-ups or as part of a regular treatment plan.

Phototherapy is a treatment where your skin is exposed to certain kinds of light, usually narrowband UVB (ultraviolet B). It can help reduce itch and inflammation. It can also help reduce the chance of infection.

Phototherapy does not work right away. You may need regular treatments for 1 to 2 months before you notice an improvement.

It is important to understand the different types of treatments available. Your doctor will consider what treatments you have had, how severe your AD is, what your symptoms are, and how much it affects your quality of life.

Remember, medicines that treat AD come in different forms, from topical treatment to systemic pill and shot. Other treatments, such as wet wraps or phototherapy, can be time consuming or take a while to show improvement.

You need to be honest with your doctor about your preferences (for example, if you prefer creams rather than ointments) or your ability to commit to the treatment, and then decide together what will work best for you.

You should notice improvement in your symptoms, like fewer rashes, smaller rashes, less redness, and less itching.

If you do not have improvement or your symptoms get worse, your doctor most likely will switch your treatment or add a new treatment.

• Is there a cure for AD?

• How will you help me get relief from my symptoms?

• What kinds of treatment are available for AD?

• What's the difference between a topical therapy and a systemic therapy?

• Why do I need a biologic?

• How does wet wrap therapy work?

• How do I know if my treatment is working?

• Will my insurance plan pay for the medicines you prescribe?

• What if I can't afford the medicines?

Congratulations!

You have successfully completed the program Understanding Your Treatment Options for Atopic Dermatitis