While many children will outgrow atopic dermatitis, there is no cure for the chronic (long-lasting) disorder. (2) Treatment focuses on managing symptoms, reducing inflammation, healing injured skin and preventing further damage, and preventing and controlling flare-ups. (1) “People with atopic dermatitis have to make many extra efforts in their day-to-day lives to take care of their skin,” explains Kanwaljit K. Brar, MD, a pediatric allergist and immunologist at NYU Langone in New York City. “People joke about their prolonged skin care routines, but for people with atopic dermatitis it is the difference between a comfortable night or a night of scratching and sleep loss.” In additional to strict skin-care routines, conventional treatments may include: (1,2)
Topical steroids and non-steroidal anti-inflammatoriesOral or injectable immunosuppressantsAntibiotics for skin infectionsPhototherapy
In recent years, however, complementary and alternative therapies have grown in popularity for numerous conditions. In fact, about one-half of patients with atopic dermatitis have reportedly used alternative and complementary treatments, per the NEA. (3) While some of these therapies appear promising, it’s important to note that most are understudied and require more research. One way to combat this dryness and put moisture back into the skin is through proper bathing or showering treatments. The NEA recommends:
Bathing or showering in lukewarm (not hot) water for no longer than 10 to 15 minutesWashing with a gentle cleanserPatting the skin dry with a towel and applying prescription topical medication to the skin as necessaryLiberally applying moisturizer within three minutesDressing only after a few minutes when the moisturizer has had time to absorb into the skin
In addition to these general guidelines, some complementary bath treatments might help ease eczema symptoms and assist the skin with moisture retention. According to the NEA, these include adding (not at the same time):
Gentle bath oils (specifically those with no fragrances or bubble bath solutions) to the bathwater to keep you moisturizedOne-quarter cup of baking soda to bathwater relieve itchingOne-quarter cup of household bleach to a full tub of bathwater to decrease inflammation and bacteria on the skinOne cup of table salt to bathwater to reduce the sting of the lukewarm water if you have a severe flareOne cup of vinegar to bathwater help kill bacteria
The NEA also suggests adding oatmeal to bathwater (or directly to skin) to relieve itching, but Dr. Brar stresses this could be dangerous for some people. “The use of food products on the skin, such as oatmeal baths, is not recommended as this may increase the risk for food allergy, or may cause skin irritation,” she says. Research suggests coconut oil (virgin or cold-pressed) has various properties that may make it an effective eczema treatment for some people. For example, one study published in January 2019 in the Journal of Traditional and Complementary Medicine found that coconut oil has anti-inflammatory and skin protective properties. (5,6) Other studies have suggested that coconut oil has antibacterial qualities and helps the skin retain moisture. (7) Sunflower seed oil may also be beneficial in treating atopic dermatitis (unless you are allergic to it). (8) One study found that sunflower seed oil can help restore the skin barrier and improve skin hydration. (9) A number of other plant-based oils are also under investigation as potential treatments for eczema symptoms, but more research is needed, according to a review published in July 2016 in the American Journal of Clinical Dermatology. (10) According to the NEA, cardiospermum (a flowering tropical vine from India and Africa) and topical vitamin B12 may be effective for eczema symptoms. (11) A review of the literature published in August 2017 in the journal Allergologie Select also noted that topical vitamin B12 shows promise according to small studies, but stresses that larger studies are needed to verify those results. (12) Single studies, however, have found that acupuncture can significantly reduce allergen-induced itch and itch related to kidney issues (uremic pruritus). (10) And a pilot study found that acupressure (in which small titanium beads are used to apply pressure instead of needles) can help reduce eczema-related itch, though the study lacked a placebo and had few patients. Another preliminary study (which also had few participants), published December 2018 in the journal Complementary Therapies in Medicine, found that acupuncture may help improve symptoms in people with atopic dermatitis. (13) A small study involving children found that massage significantly reduced atopic dermatitis symptoms, including itch, scaling, and redness, as well as anxiety. (10) Adding essential oils to massage had no additional benefit (and may even sensitize the skin to the oils), according to another study. Patients should be careful with essential oils (not to be confused with common bath oils), Brar notes. “Families will often try homemade concoctions of multiple essential oils that I recommend against,” she says. “Essential oils may cause contact dermatitis and the fragrance may irritate the skin.” Other studies have found a potential benefit to hypnotherapy and biofeedback (a relaxation or awareness technique that involves a physiological feedback device combined with directed thoughts). These two treatments appear to reduce skin damage through relaxation. Research, such as a study published in April 2018 in the journal Cognitive Behaviour Therapy, has also shown that exposure-based cognitive behavioral treatment (which uses mindfulness to increase tolerance for itch and distress during exposure to atopic dermatitis triggers) may reduce symptoms and anxiety. (14) It’s well-known now that the microbiome — the trillions of microorganisms living within the human body, particularly the gut — plays a substantial role in our overall health. A number of studies have therefore looked into whether improving the health of the microbiome with probiotics can reduce inflammation and eczema symptoms. Though some studies suggest probiotics are effective, literature reviews, such as a meta-analysis published in September 2017 in Frontiers in Cellular and Infection Microbiology, have yet to reveal a clear benefit to the treatment. (15) For instance, a November 2018 Cochrane Review of randomized controlled clinical trials concluded that currently available probiotic strains make little to no difference in improving eczema symptoms, but probiotics generally don’t cause significant side effects. (16) Vitamin D supplements have similarly gained a lot of research attention because people with vitamin D deficiency appear more likely to have atopic dermatitis and to develop a more severe form of the disease. But individual studies have had mixed conclusions. One literature review of randomized control trials, published in October 2018 in the journal Pediatric Dermatology, found that there is definitely a link between vitamin D levels and atopic dermatitis disease severity. (17) It also found that there’s “weak evidence” that vitamin D supplementation improves symptoms in children, though it noted that only six studies were included and they were inconsistent in design and methods. Another review, published in September 2016 in Nutrition, also noted this inconsistency. (18) The authors concluded that vitamin D can potentially improve atopic dermatitis symptoms, but this finding will need to be confirmed with larger-scale studies conducted over a longer period of time. The bottom line: Complementary therapies work best in tandem with traditional treatments. Before trying one, be sure to have a discussion with your dermatologist.
