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• Overview
• Signs & symptoms of atopic dermatitis
• Area of the body commonly affected by atopic dermatitis
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• Assessment
• General Management
• Education

Management

Education

A patient presenting with a flare of atopic dermatitis will often be most concerned about immediate relief of their most bothersome symptoms. In this regard, their physician plays a key role not only in prescribing an appropriate short-term treatment, but in educating the patient (and/or their carer if the patient is very young) on the nature of the disease and what can be done to help prevent recurrence of flares over time.

Treatment adherence can be an issue in atopic dermatitis as the patient/their carer can become less mindful of the disease and the need for treatment as their symptoms improve and they enter a period of remission.

Compliance is decreased, particularly during periods of remission. It should be explained that atopic dermatitis is a result of changes in the skin that are present even when the skin appears normal. The patient can then be made aware of the therapies available that control these underlying changes and extend periods of remission as appropriate.

Some of the important questions and issues to consider in discussion with the patient/their carer to promote treatment adherence are presented below.

• Does the patient have a basic understanding of their condition and treatment?
  • The patient is more likely to persist with treatment if they understand how and why it works.
• Is the patient surrounded by supportive family members who understand the need to persist with the chosen treatment?
  • This is especially important in young children who may rely on family members to apply the treatment and/or remind them of the importance of sticking with their treatment even if it becomes tiresome as their symptoms improve.
• What symptoms does the patient find most bothersome during disease flares?
  • The patient is more likely to adhere to their treatment strategy if they remember the impact a disease flare has on their quality of life when at its most severe.
• Are there any life events during which a flare would be especially impactful (e.g. change of school, exams)?
  • Advise the patient of the importance of persisting with a long-term treatment strategy to minimise the risk of a flare during these times.
• Address any concerns that the patient/their family may have relating to drug safety
  • The patient may have heard worrying reports on the safety of steroid treatments, or may have experienced some degree of side effects themselves. Reassure the patient about their chosen treatment strategy.

After the patient has been diagnosed with atopic dermatitis and the severity of disease assessed, it is imperative that they are informed of all of their options relating to treatment. A number of healthcare organisations have developed guidance for physicians on the management of atopic dermatitis which provide a useful reference where further information is required. It should be noted that guidelines may become outdated, particularly when new management options become available (e.g. twice-weekly use of tacrolimus ointment), so this information should be used in conjunction with the most recent clinical evidence and publications in the area.

Guidelines on the management of atopic dermatitis can be accessed via the links below.

• National Institute for Health and Clinical Excellence
  • In Children
  • Steroid use
  • Pimecrolimus and tacrolimus
• American Academy of Dermatology
• British Association of Dermatologists
• Protopic (Tacrolimus ointment) Summary of Product Characteristics

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