Eczema is a common chronic skin inflammation, with treatment goals aimed at relieving itching, reducing skin redness and swelling, repairing the skin barrier, and preventing recurrence. Treatment plans need to be personalized based on the patient's age, severity of symptoms, and stage of the disease, with long-term management being key to controlling the condition.
Treatment strategies typically combine pharmacological and non-pharmacological methods, emphasizing patient education and daily care. The medical community recommends a stepwise treatment approach, gradually adjusting treatment intensity based on the severity of the condition while monitoring for side effects and efficacy.
Recent studies have shown that combined therapies that modulate the immune system and repair the skin barrier can significantly improve patients' quality of life. The following sections will detail the principles, usage methods, and precautions for each treatment option.
Eczema treatment is divided into two main phases: the acute flare-up phase and the chronic maintenance phase. The acute phase focuses on quickly relieving symptoms, which may involve using high-dose medications; the chronic phase shifts towards long-term control and prevention. The main treatment modalities currently include:
Treatment options must consider the patient's age; for example, infants should avoid potent steroids, while adolescents and adults can use more flexible treatment combinations. Physicians will develop a phased treatment plan based on the affected area of the skin, the degree of itching, and the risk of complications.
Topical steroids are currently the most common first-line treatment medications, classified into seven potency levels, from weak 1% hydrocortisone to potent fluticasone propionate. Mild symptoms can be treated with weak medications on the face and in skin folds, while severely inflamed areas may require short-term use of medium to potent medications.
Correct usage includes applying a thin layer to the affected area 1-2 times daily, using for no more than 2 weeks during acute flare-ups, and switching to weaker medications for maintenance during chronic phases. Long-term use may lead to skin atrophy or folliculitis, so dosage adjustments should be made under physician guidance.
Non-steroidal medications such as tacrolimus and pimecrolimus are used for patients who do not respond well to steroids or require long-term treatment. These medications can inhibit T lymphocyte activation and reduce inflammatory responses. They are suitable for sensitive areas such as the face and armpits, but may cause initial burning or stinging sensations.
New biologics like IL-4/13 inhibitors have been approved for moderate to severe eczema, significantly reducing symptoms by blocking specific inflammatory factors. These medications require subcutaneous or intravenous injections and are suitable for adult patients who have failed traditional treatments.
Oral antihistamines (such as cetirizine) can relieve nighttime itching, with second-generation medications having fewer side effects. If there is a Staphylococcus aureus infection, topical or oral antibiotics are needed to prevent worsening of purulent skin lesions.
Narrowband UVB or PUVA therapy can inhibit epidermal cell proliferation and inflammatory mediators, suitable for adult patients with extensive body involvement. Treatments are typically performed 2-3 times a week in professional medical institutions to avoid the risk of excessive UV exposure.
The emerging 308 nanometer excimer light therapy targets specific lesions, reducing the risk of damage to normal skin, making it suitable for facial or distal lesions.
Wet Wrap Therapy involves covering the affected area with a wet dressing containing medication, enhancing drug absorption and keeping the skin moist. This method is often used for children with severe itching or redness, and the temperature of the dressing must be controlled to avoid irritation.
Cold compresses or ice packs can provide immediate relief from itching, but direct contact with the skin should not exceed 15 minutes to prevent frostbite. Applying a moisturizer immediately after icing is more effective.
Behavioral therapy includes itch management techniques, such as using cold compresses and wearing cotton gloves, to help patients avoid scratching the skin. Psychological counseling can improve anxiety or depression caused by long-term skin issues, especially in adolescents who are severely troubled by their appearance.
Apply a fragrance-free emollient at least twice daily, ideally within 3 minutes after bathing for best results. Products containing ceramides and urea can help repair skin barrier function.
Avoid bathing in hot water; the water temperature should be below 38°C, and bathing time should be limited to 10 minutes. The moisturizing routine after bathing should become a daily habit to reduce the likelihood of symptom rebound.
Maintain indoor humidity between 40-60%, using dehumidifiers or air purifiers to reduce dust mites and allergens. Bed linens and clothing should be made of 100% cotton, and washed weekly at temperatures above 60°C to kill allergenic bacteria.
Some patients may trigger symptoms due to specific foods, so keeping a food diary to track potential triggers is recommended. Omega-3 fatty acids and vitamin D supplements may help modulate immune responses, but should be used after physician evaluation.
Stress management is an important aspect of preventing flare-ups; mindfulness meditation and regular exercise can lower cortisol levels, thereby reducing inflammatory responses. Patients should establish a daily relaxation practice of at least 15 minutes.
Gene therapy and allergen immunotherapy are currently in clinical trial stages, with new oral medications targeting the IL-31 receptor or JAK-STAT signaling pathways potentially reducing the need for long-term steroid use. Minimally invasive treatments, such as microneedling to introduce moisturizing ingredients, are being developed to enhance skin barrier repair.
AI-assisted diagnostic systems can analyze skin images in real-time, helping physicians adjust treatment plans. Personalized medicine combined with genetic testing may allow for more precise treatment plans based on patients' IL-4Rα gene expression levels in the future.
Seek medical attention immediately if the following occurs: symptoms do not improve within 72 hours, yellow crusts or pustules appear on the skin, or fever accompanies expanding skin redness. If persistent scratching leads to dermal damage, signs of infection, or resistance to traditional medications, referral to a dermatologist for evaluation is necessary.
For pediatric patients, if itching affects sleep or activity levels, symptoms impact mental health, or home care measures are ineffective, a specialist outpatient appointment should be arranged. Physicians may recommend allergen testing, adjust medication dosages, or perform secondary phototherapy.
Patients can choose low-allergen, fragrance-free cosmetics but should avoid products containing preservatives (such as MIT, CI), fragrances, or alcohol. It is recommended to perform a patch test on a small area of skin to observe for any irritation or inflammatory reactions. Choosing products labeled "hypoallergenic" or "suitable for sensitive skin" is safer.
What non-pharmacological methods can alleviate atopic dermatitis symptoms in daily life?Maintaining skin hydration is key; using fragrance-free lotions or ointments daily to lock in moisture is essential. Avoiding scratching can prevent skin damage; it is advisable to keep nails trimmed and wear cotton clothing to reduce friction. For environmental control, using a humidifier to maintain indoor humidity at 40-60% and regularly cleaning bedding to reduce dust mite triggers is recommended.
During winter, when skin dryness often exacerbates atopic dermatitis symptoms, what measures can be taken?Winter heating can lead to excessive skin dryness; it is recommended to keep bath water temperature below 32°C and complete bathing within 5 minutes. Immediately after bathing, use oil-based products or thick creams (such as petroleum jelly) to lock in moisture. Additionally, using moisturizers containing urea or lactic acid can help restore skin barrier function.
Does the use of steroid ointments lead to skin thinning or resistance? How should they be used correctly?Short-term use of moderately potent steroids as directed is usually safe, but long-term use of high-potency steroids may lead to skin thinning or telangiectasia. It is recommended to use medications in a targeted manner as directed by a physician: stronger ointments can be used on the body trunk, while weaker types should be chosen for the face or skin folds. After symptoms improve, the dosage should be gradually reduced, focusing on moisturizing.
Can patients with atopic dermatitis receive vaccinations? Are there any special precautions?Patients can receive vaccinations normally, but care should be taken to avoid vaccination in areas of skin that already have eczema. If immunosuppressants (such as cyclosporine) are being used, the physician should be informed to assess vaccine efficacy. If redness occurs after vaccination, it may be a normal reaction, but if accompanied by purulence or severe itching, immediate medical evaluation for infection risk is necessary.
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