Andrew Alexis, MD, MPH, FAAD: We spoke about pharmacological approaches to treatment of most conditions. Atopic dermatitis is 1 example where a broader approach often leads to greater outcomes. There may be some nonpharmacological approaches that are adjunctive and can be helpful for our patients.
Heather, I know you take a special interest in lifestyle modification and the role of that in managing dermatologic disorders. Can you speak about some nonpharmacological approaches and lifestyle modification that you think is beneficial for atopic dermatitis?
Heather Woolery-Lloyd, MD: Definitely. We definitely need more research in that area. This is a growing field, looking at how lifestyle changes like diet, sleep, exercise, and stress reduction interplay with chronic diseases. We all know atopic dermatitis is a chronic disease.
The biggest thing that has an impact on atopic dermatitis, especially in adults, is stress. All our patients—we know all skin diseases get worse with stress. Acne gets worse with stress. Psoriasis gets worse with stress. But with atopic dermatitis, when people have higher stress levels in their life, they’re more itchy, more uncomfortable. Managing stress is important.
I always love to mention the study, which is a beautiful study done of babies. They used the intervention of baby massage. And they found that the children who received the baby massage had improvement in their eczema compared with the babies who didn’t. This study was done at my department, at the department of dermatology at the University of Miami Miller School of Medicine, by Dr Lawrence Schachner. They taught the parents baby massage, and those kids did better. Simple things. Like, we don’t think of stress in babies, but that massage must release some endorphins and all the positive good things, and those babies did better. The biggest lifestyle factor, as I mentioned, is stress and stress reduction.
Sleep is a big 1, and that’s an interplay between eczema or atopic dermatitis and sleep, because atopic dermatitis makes you not sleep as well. You don’t have restful, restorative sleep. Of course, not having restful, restorative sleep makes you more agitated during the day and probably more likely to be irritated by atopic dermatitis. If you get a good night’s sleep, you might have less itch the next day. Those are the 2 big ones that stand out to me, but I think we’ll see more research on the effects of lifestyle changes on this particular chronic disease.
Andrew Alexis, MD, MPH, FAAD: Staying on the subject of nonpharmacological treatments, we all recognize the importance of moisturization in the management of atopic dermatitis. I’d love to hear some of your favorite ingredients. What are your recommendations when it comes to moisturization and maintaining a healthy barrier? What ingredients should patients look for? What types of formulations are particularly useful for atopic dermatitis? Why don’t we start with Candrice?
Candrice Heath, MD: Oftentimes, I tell my patients that I want them to use something very heavy. I am a huge fan of the soak and smear technique. I like for my patients to do a short shower, and then after that short shower or bath to get out. Within 3 minutes, I want them to do their moisturizing routine. If it is time for medication, I encourage them to bring that medication into the bathroom, apply to the areas that are inflamed, and then cover the entire body with a heavy moisturizer.
That heavy moisturizer may be of the patient’s preference. I often challenge them to do something that is going to be heavy, especially at night. But those ingredients may include petroleum, or petrolatum, for example. That is contained in multiple products and easy for patients to find. I find that that is 1 of the top ingredients is in a lot of the products I recommend, specifically for my patients with very moderate to severe atopic dermatitis.
Andrew Alexis, MD, MPH, FAAD: Great. Thank you. Jamie, what’s your approach to moisturization and skin care as far as maintaining a healthy barrier?
Jamie Weisman, MD: I do a lot of the things that Candrice does as well, especially because it is an area where I compromise on the amount of bathing that you’re going to do. You can bathe, but I need you to moisturize. This is an area where, obviously, most of us avoid heavily scented things. We don’t want things with dyes or irritants because these children and adults are also more prone to developing contact dermatitis. We want the simplest of simple ingredients.
But this is an area where we will compromise with patients. If they have found that the extra olive oil or shea butter really does work better for them and isn’t irritating them, then that’s acceptable to me, as long as we’re staying away from things that are heavily fragranced and perfumed and have too many ingredients. Simple is always better.
Andrew Alexis, MD, MPH, FAAD: Well said. Heather?
Heather Woolery-Lloyd, MD: Yes, I agree. Fragrance-free is huge, and I typically do use a lot of petrolatum, especially at night, under pajamas when you’re with kids. I always say you must be totally covered. You can’t use too much, because people tend to use less than more. I emphasize being liberal with your application of the petrolatum at night.
During the day, practicing in Florida, sometimes a petrolatum-based product isn’t as tolerable because of the humidity and the heat. Then creams and lotions are good. I also like ceramide-based creams because they help restore the barrier. There is a lot of interesting research on topicals that alter the microbiome. We haven’t talked too much about that. But there are some data to show that the microbiome is altered or abnormal—dysfunctional in patients with atopic dermatitis. When we restore the microbiome to normal heterogenous of all types of bacteria, the atopic dermatitis gets better. There are some novel moisturizers out there that address the microbiome.
As everyone said, the key is to use a moisturizer and use it liberally. There are lots of theories on which ones work and why they work. But if you’re using something and using it liberally and not having any extra fragrance or unwanted chemicals, you get great results.
Transcript Edited for Clarity