Skin Health Matters: Optimizing Moisturizers and Hygiene Routines
An expert discusses proactive management strategies for atopic dermatitis (AD), emphasizing daily gentle skin care, proper use of topical treatments, avoidance of outdated therapies such as routine antihistamines or steroids, and a shift toward personalized, flare-preventive care using newer therapeutic options.
This section highlights key strategies in the proactive management of AD, particularly focusing on skin care practices, medication application, and treatment philosophies. A common misconception is that bathing worsens eczema, but evidence shows that daily bathing followed by liberal emollient application actually helps improve symptoms. Patients are advised to use gentle, fragrance-free products and lukewarm water, not cold. Moisturizers should be applied at least twice daily, especially after bathing, to lock in moisture. On whether to apply medication or emollient first, US guidelines recommend applying topical prescriptions first, whereas UK guidance suggests it doesn’t significantly matter. Regardless, the speaker advises letting medication absorb before moisturizing.
Clinical recommendations stress that emollients are essential not just for flare management but also for ongoing maintenance. Antibiotics should be reserved for cases of true secondary infection, indicated by yellow crusting. Common allergy tests such as Radioallergosorbent (RAST) and skin prick testing are not routinely necessary, as true allergies only account for a small percentage of AD cases. Similarly, long-term use of oral or intramuscular steroids should be avoided, and antihistamines are now rarely used due to better understanding of the condition’s inflammatory basis. Eczema-related itch is driven by inflammatory cytokines rather than just histamine, which is why antihistamines often fail to provide meaningful relief and only induce sedation.
The final discussion centers around proactive vs reactive treatment. Historically, treatment occurred only during flares, often with steroids. However, new topical, oral, and systemic options now allow for ongoing control to prevent flares. This marks a shift in how providers manage chronic cases. When attendees were polled about treatment priorities, most ranked treatment effectiveness highest, followed by concerns about adverse effects, cost, and then patient preference. Given the diverse presentations of AD—across age, severity, and skin tone—the speaker emphasizes personalized care approaches tailored to the individual’s specific disease course and needs.
Newsletter
Enhance your clinical practice with the Patient Care newsletter, offering the latest evidence-based guidelines, diagnostic insights, and treatment strategies for primary care physicians.
