Efficacy and Safety Considerations in Topical Treatments for Atopic Dermatitis

Noreen Heer Nicol, MS, RN, FNP


Dermatology Nursing. 2010;22(3):2-11. 

In This Article


Patient education is paramount in managing AD. The itch-and-scratch cycle of AD exacerbates symptoms, and breaking this cycle is critical in managing this chronic disease. Providing patients with detailed verbal and written instructions about proper daily skin care is key in optimizing clinical outcomes. Improper bathing and moisturizing are common causes of symptom exacerbation. Patients are often confused by the apparent contradiction bathing can both dry and hydrate the skin. Proper soaking and sealing of the skin leads to rehydration, sealing in of moisture, and repair of the damaged epidermal barrier. Even with conscientious skin care, however, patients usually still require pharmacologic treatment. Treatment should be individualized according to patient characteristics and disease severity. A combination approach may be used to calm the flare with a topical corticosteroid for several days, followed by initiation of a topical calcineurin inhibitor. Topical calcineurin inhibitors are particularly useful in treating the face and other thin, sensitive areas of the skin. Patients should be advised about the potential side effects of selected pharmacologic treatment, as compliance increases when patients know what to expect with treatment. With support and education, patients can learn to anticipate and avoid triggers as well as effectively treat flares when they occur.