Treatment Recommendations Successful management requires a systematic, multipronged approach that includes skin hydration, emollients, topical corticosteroids, and the identification and possible elimination of exacerbating factors including irritants, allergens, emotional stressors, and infectious agents.
Scratching plays an important role in the development of cutaneous lesions in atopic dermatitis.
Control of pruritus is therefore an important part of treatment, recognizing that patients may experience both exogenous and endogenous provocation factors. Dry skin in the winter months damages the stratum corneum barrier causing an increased susceptibility to irritants and increased itching, whereas sweating in the warm humid months of the summer may also trigger itching. Patients with atopic dermatitis tend to have an intolerance to wool fiber because of its irritating effect on the skin, but any irritants including soaps and lipid solvents, may provoke pruritus. Clearly, many factors may lead to an intensification of pruritus and treatment plans should be individualized to address trigger factors that are unique to the individual patient. In patients refractory to first line therapy, other anti-inflammatory and immunomodulatory agents may be necessary.