Atopic dermatitis, or eczema, has a profoundly negative physical, psychosocial, and economic impact on patients and their families¹

A chronic skin condition characterised by itchy, dry, skin that’s prone to infection, there's no cure for atopic dermatitis.^2,3 However, effective management can significantly reduce flare-ups and improve quality of life.³

TIPS AND STRATEGIES FOR PREVENTING FLARE-UPS

1. Skincare routine

• Moisturisation: Encourage patients to use a fragrance-free emollient at least twice daily, especially after bathing. This helps to lock in moisture and maintain the skin barrier.^4,5
• Bathing: Advise on short, lukewarm baths or showers, lasting no more than 10-15 minutes. Recommend the use of gentle, soap-free cleansers to avoid stripping the skin of its natural oils.⁴
• Pat dry: Instruct patients to pat the skin dry with a soft towel rather than rubbing, which can irritate the skin.⁴
• Wet wraps: For severe flare-ups, consider wet wrap therapy after moisturising, which can help soothe and hydrate the skin.⁵

2. Avoiding irritants

• Fragrance-free products: Recommend the use of fragrance-free, hypoallergenic products for skincare, laundry, and household cleaning.^1,6,7
• Clothing choices: Suggest wearing soft, breathable fabrics like cotton. Advise against wool or synthetic fabrics, which can be irritating.⁸
• Patch testing: For new skincare or household products, recommend patch testing on a small area of skin before full application.⁹

3. Environmental modifications

• Humidity control: Advise the use of humidifiers, especially in dry climates or during winter, to keep indoor air moist.¹⁰
• Allergen reduction: Encourage regular cleaning to reduce dust, mould, and pet dander. Suggest using allergen-proof covers on mattresses and pillows.¹¹
• Temperature regulation: Recommend keeping the home at a comfortable, stable temperature to avoid extremes that could dry out or irritate the skin.¹²

4. Managing stress

• Stress-reduction techniques: Encourage practices such as mindfulness, meditation, and regular exercise to help manage stress levels.¹³
• Sleep hygiene: Advise on maintaining good sleep habits, as poor sleep can exacerbate stress and skin symptoms.¹⁴

5. Diet and Hydration

While the relationship between diet and atopic dermatitis isn't fully understood, some patients may benefit from dietary adjustments.

• Food triggers: Encourage patients to keep a food diary to identify potential dietary triggers. If specific foods seem to exacerbate symptoms, a referral to a dietitian may be appropriate.¹⁵
• Hydration: Remind patients to stay well-hydrated, as this supports overall skin health.⁸

6. Medication adherence

For patients with more severe atopic dermatitis, adherence to prescribed medications is crucial.

• Topical treatments: Ensure patients understand the correct application of topical corticosteroids or calcineurin inhibitors.^1,4,5 Emphasise the importance of applying these medications to affected areas as prescribed.¹
• Systemic treatments: For patients on systemic treatments, stress the importance of regular follow-ups and adherence to therapy, even when symptoms improve.¹

Flare-ups can be distressing for patients, and as pharmacists, you play a crucial role in educating and guiding them to manage and prevent these episodes effectively. Emphasise the importance of regular follow-ups to monitor the condition, adjust treatment as needed, and address any concerns.¹

REFERENCES

1. Wong ITY, Tsuyuki RT, Cresswell-Melville A, Doiron P, Drucker AM. Guidelines for the management of atopic dermatitis (eczema) for pharmacists. Can Pharm J (Ott). 2017 May 30;150(5):285-297. doi: 10.1177/1715163517710958. PMID: 28894498; PMCID: PMC5582672. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5582672/ 
2. Nemeth V, Syed HA, Evans J. Eczema. [Updated 2024 Mar 1]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK538209/ 
3. InformedHealth.org [Internet]. Cologne, Germany: Institute for Quality and Efficiency in Health Care (IQWiG); 2006-. Overview: Eczema. [Updated 2021 Feb 11]. Available from: https://www.ncbi.nlm.nih.gov/books/NBK279399/ InformedHealth.org [Internet]. Cologne, Germany: Institute for Quality and Efficiency in Health Care (IQWiG); 2006-. Overview: Eczema. [Updated 2021 Feb 11]. Available from: https://www.ncbi.nlm.nih.gov/books/NBK279399/ 
4. Frazier W, Bhardwaj N. Atopic Dermatitis: Diagnosis and Treatment. Am Fam Physician. 2020;101(10):590-598. Available from: https://www.aafp.org/pubs/afp/issues/2020/0515/p590.html 
5. Eichenfield LF, Tom WL, Berger TG, Krol A, Paller AS, Schwarzenberger K, Bergman JN, Chamlin SL, Cohen DE, Cooper KD, Cordoro KM, Davis DM, Feldman SR, Hanifin JM, Margolis DJ, Silverman RA, Simpson EL, Williams HC, Elmets CA, Block J, Harrod CG, Smith Begolka W, Sidbury R. Guidelines of care for the management of atopic dermatitis: section 2. Management and treatment of atopic dermatitis with topical therapies. J Am Acad Dermatol. 2014 Jul;71(1):116-32. doi: 10.1016/j.jaad.2014.03.023. Epub 2014 May 9. PMID: 24813302; PMCID: PMC4326095. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4326095/ 
6. Laundry Care for People with Eczema. National Eczema Association. Available from: https://nationaleczema.org/laundry-care-for-people-eczema/ 
7. Eczema Skin Care: Products and Routines. Cleveland Clinic. 15 December 2023. Available from: https://health.clevelandclinic.org/eczema-skin-care 
8. Eczema. Cleveland Clinic. Available from: https://my.clevelandclinic.org/health/diseases/9998-eczema 
9. How to test skin care products. American Academy of Dermatology Association. 10 August 2021. Available from: https://www.aad.org/public/everyday-care/skin-care-secrets/prevent-skin-problems/test-skin-care-products 
10. Gallagher M. 6 Tips to Manage Eczema in the Winter. National Eczema Association. 1 February 2024. Available from: https://nationaleczema.org/blog/six-tips-for-keeping-eczema-calm-in-winter/ 
11. Allergy-proof your home. Mayo Clinic. 22 December 2022. Available from: https://www.mayoclinic.org/diseases-conditions/allergies/in-depth/allergy/art-20049365 
12. Hui-Beckman JW, Goleva E, Leung DYM, Kim BE, The impact of temperature on the skin barrier and atopic dermatitis. Annals of Allergy, Asthma & Immunology. 16 August 2023. Available from: https://doi.org/10.1016/j.anai.2023.08.007 
13. Stress and eczema. National Eczema Society. Available from: https://eczema.org/information-and-advice/triggers-for-eczema/stress-and-eczema/#:~:text=Give%20your%20body%20the%20resources,%E2%80%93%20especially%20during%20flare%2Dups. 
14. Sleep and eczema. National Eczema Society. Available from: https://eczema.org/information-and-advice/living-with-eczema/sleep-and-eczema/ 
15. Katta R, Schlichte M. Diet and dermatitis: food triggers. J Clin Aesthet Dermatol. 2014 Mar;7(3):30-6. PMID: 24688624; PMCID: PMC3970830. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3970830/