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The redness, discoloration, dryness, and itching of atopic dermatitis (AD) might send you to your dermatologist for solutions. Your doctor will first take stock of your symptoms.

“The first thing to do is assess the severity of the condition,” says Lindsay Strowd, MD, associate professor of dermatology and vice chair of the division of dermatology at Wake Forest Baptist Health.

Doctors determine how severe your Alzheimer’s disease is based on the affected body surface. The more areas of inflamed skin you have, the more severe your condition. They also look at the area of ​​your body where AD is located. Also, severe AD tends to be deeper red, Strowd says. But for some with darker skin, the skin may appear discolored rather than red. It may even become lighter after the acute inflammation has subsided. Their skin can be thicker than normal and can break open if you scratch it severely.

Another sign that you need more intensive treatment is that topical medications have not brought the redness, discoloration, and itching under control. AD itch can be severe enough to interfere with your sleep and work. Your doctor will ask you how itchy you are and how AD is affecting your daily life. “These components will guide our treatment decisions,” says Strowd.

creams and phototherapy

A topical treatment might be enough to treat a mild case of AD. Coal tar has been used to treat AD and other skin conditions for more than 100 years. Steroid creams help control the itching and give your skin a chance to heal. Calcineurin inhibitors like pimecrolimus (Elidel) and tacrolimus (Protopic) reduce the immune response to reduce inflammation in your skin.

A newer type of topical treatment is crisaborole (Eucrisa). This ointment relieves inflammation, itching and skin rashes in people aged 2 and over.

A group of new drugs called Janus kinase (JAK) inhibitors have been approved for AD. They block a pathway that leads to the release of inflammatory chemicals in the body. Ruxolitinib (Opzelura) is available as a cream.

Phototherapy, also called light therapy, is an option if you have AD over large areas of your body. Your dermatologist may also recommend this treatment for blemishes on areas like your hands and feet that don’t improve with topical treatments. Phototherapy uses ultraviolet (UV) light to clean your skin.

If you have severe AD or your skin isn’t improving with these treatments, it might be time to consider body-wide or more advanced therapies.

Body wide treatments

Systemic medications work throughout the body to treat larger areas of AD. Dermatologists use some drugs off-label, meaning they’re approved to treat other conditions, but they work on AD as well.

A body-wide treatment is cyclosporine, which suppresses the response of your overactive immune system. “This is a very powerful drug that reduces inflammation in the skin,” says Jon Hanifin, MD, professor emeritus of dermatology at Oregon Health and Science University School of Medicine.

Other drugs that work in a similar way include:

  • Azathioprine (Azasan, Imuran)
  • Methotrexate (Rheumatrex, Trexall)
  • Mycophenolate mofetil (CellCept)

A downside to these treatments is that they can have serious side effects, including:

  • kidney or liver damage
  • High blood pressure
  • tremors (tremors)
  • Muscle aches
  • electrolyte imbalances

Newer ways to treat moderate to severe AD

In 2017, the FDA approved the first biologic drug for AD, called dupilumab (Dupixent). It treats moderate to severe AD in adults and children 6 years and older.

Dupixent is given as an injection under the skin every 2 weeks. It blocks two proteins that cause inflammation in AD: interleukin-4 (IL-4) and interleukin-13 (IL-13).

“If you think the skin is burning, then a drug like methotrexate or prednisone [a steroid] act like a fire blanket. It smothers the fire,” says Strowd. “Whereas a drug like Dupixent is like taking a fire extinguisher and shooting at the source of the fire. It’s a much more specific goal.”

In studies, Dupixent cleared skin, relieved itching and improved quality of life in people with AD. More than half of those who took it for 16 weeks said they had 75% fewer symptoms. These improvements last over the long term.

Strowd calls Dupixent “a real turning point”. “It has been very successful in rapidly improving both the skin condition and the itching,” she says. (Strowd participated in clinical trials for Dupixent.)

Dupixent is safe too. The most common side effects are mild, including:

  • Skin reactions where you got the injection
  • Cold sores in the mouth or on the lips
  • Eye and eyelid redness, swelling and itching
  • pink eye

A downside to Dupixent is its cost, which tops $3,200 per shot. How much you actually pay depends on the type of health insurance you have. Your insurance company may want you to try cheaper drugs first before covering the cost of Dupixent, Hanifin says.

Another biologic, tralokinumab-ldrm (Adbry), was approved by the FDA in December 2021 for adults ages 17 and older. It is also an interleukin inhibitor that blocks IL-13. They take it as a shot every other week. The side effects are similar to those of Dupixent. The costs are similar too, so you’ll need to check your insurance coverage to see if it’s covered for you.

Some JAK inhibitors can be taken as pills, which might be a plus if you don’t like needles. These include the drugs abrocitinib (Cibinqo) and upadacitinib (Rinvoq).

Life changing treatments

New treatments like Dupixent have improved the outlook for people with Alzheimer’s. They have enabled many people with this condition to have clear or almost clear skin.

“It’s life changing for people when they’ve suffered, absolutely,” says Strowd. “It’s a very rewarding part of treating this disease in our modern era.”

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