The “treatment principles” are the basic guidelines that doctors follow in the treatment process.
Principle 1: Comprehensive treatment
The so-called “comprehensive treatment” is certainly not a single treatment method, atopic dermatitis / eczema comprehensive treatment of the three major assets: anti-inflammatory, moisturizing, patient education.
1. Anti-inflammatory
The topical anti-inflammatory drugs with definite efficacy are topical glucocorticoids or topical calcium phosphatase inhibitors (Tacrolimus/Pimecrolimus), which are the first-line drugs for the treatment of atopic dermatitis/eczema, and their efficacy and safety have been confirmed by a large number of long-term clinical studies.
The most common problem with anti-inflammatory therapy is the patient’s “fear” of the drug, and the most direct result is an inadequate course of treatment and poor disease control.
2. Moisturizing
It is to use a lot of moisturizing emollients for a long time to relieve the dryness of the skin and repair the skin barrier function. The use of moisturizing emollients is the basic treatment of atopic dermatitis / eczema, whether mild eczema, or severe eczema, or eczema has been healed and receded, you need to continue to do a good job of skin moisturizing.
3. Patient education
After many years of seeing atopic dermatitis/eczema clinics, I truly feel the importance and difficulty of patient education. How to use topical medication? How to apply moisturizer? Do I need to check for allergens? Do I need to avoid eating? Patients have questions and confusion in every aspect of their lives and need answers from their doctors.
The most frightening thing is that in such an era of information explosion, patients can get information through many ways, how to distinguish the true from the false, the right from the wrong? That’s why I spend a long time “brainwashing” every time I see a patient for the first time, hoping to help the patient discard those incorrect opinions and misinformation. Later, during each follow-up visit, I continue to correct any incorrect treatment behaviors. In short, patient education is a long way to go!
Principle 2: Stepped Therapy
Atopic dermatitis/eczema is a relapsing disease, so it may be severe or mild at times. During treatment, the doctor needs to adjust the type and strength of medication according to the severity of the patient’s condition.
A ladder is a step, either up or down. For a patient who is first diagnosed, the doctor will assess the severity of the disease, give the appropriate treatment, and when the treatment improves, he or she will go down a step and use a drug with a weaker anti-inflammatory effect and better safety profile. And when the patient’s condition relapses and worsens, he or she needs to go up a step and use stronger drugs to control the condition.
This is why patients are required to come in for regular follow-ups during the treatment process, especially during the initial phase of treatment. Usually, for the initial diagnosis, patients are asked to come for a follow-up visit on average once every 2 weeks. When the eczema subsides and remains stable, with only dry skin problems, the follow-up visit is extended to once every 1-2 months.
Principle 3: Active maintenance therapy
Atopic dermatitis/eczema is often associated with a genetic predisposition and is not currently curable. Recurrent flare-ups are troubling, and many doctors are trying to find ways to reduce the recurrence of the condition, one very important point in reducing eczema flare-ups is maintenance therapy.
Many patients who are treated with topical hormones as required by their doctors find that the rash soon disappears and they assume that their eczema is cured. If we take a piece of skin that has improved under the microscope, there are still many inflammatory cells, which is the reason why eczema comes back soon after stopping the medication. Therefore, it is important not to stop using anti-inflammatory drugs immediately after treatment has improved, but to gradually reduce the number of doses and to maintain treatment in areas where eczema can easily recur.
How long does maintenance treatment take? For patients with mild disease at the time of initial treatment, maintenance treatment should be continued for 2-3 months. For patients with more severe disease at the time of initial treatment, maintenance therapy should last approximately 6-9 months.
The biggest concern for patients on maintenance therapy is that if the eczema has disappeared and the medication is continued, won’t this result in additional medication use? In several large clinical studies, it was found that with regular maintenance therapy, the disease continued to remit and the amount of anti-inflammatory medication used did not increase or even decreased compared to the “relapse-treatment-discontinuation-relapse-treatment” process.