Nonprescription therapies for treating atopic dermatitis

Atopic dermatitis (AD) is a common skin condition, seen in up to 20% of children worldwide. Multiple prescription therapies have been developed and are undergoing development for alleviating AD symptoms. However, there are also nonprescription therapies available for treating AD.

As skin barrier dysfunction is a common source of AD, moisturizers and emollients are frequently used to alleviate AD symptoms in pediatric patients. Frequent reapplication of these products is recommended to keep the skin from drying.

Wet wrap therapy (WWT), a process where a moisturizer or TCS is applied followed by a damp bandage or gauze and left on for 8 to 24 hours, is also used to alleviate symptoms during AD flares. Adverse events include skin atrophy from TCS and folliculitis from occlusion emollients, making long-term use of WWT not recommended.

Bleach baths are an inexpensive treatment that are useful for patients with reoccurring skin infections. One study saw decreased AD severity in children after bleach baths, but further research is needed on their efficacy.

Natural oils could be considered an alternative treatment, but some studies have found no benefit to certain oils such as evening primrose oil. Other oils, such as sunflower seed oil, have been observed with anti-inflammatory and barrier repair properties.

Certain studies have examined the impact of vitamins and antioxidants on pediatric AD. In these studies, oral vitamin D supplements were associated with improvements in the severity of AD. Authors noted that topical vitamin D should be avoided however, as it could worsen AD. Certain vitamins, such as topical vitamin B12, have been associated with preventing AD flares.

An association has also been made between gut health and the skin barrier. This has led investigators to theorize that probiotics could reduce AD severity, and some studies have shown positive results. Dosing, efficacy, formulation, and adverse event concerns have kept probiotics from being used commonly.

Sleep disturbance has also been associated with AD, leading investigators to consider melatonin for treating AD symptoms. One trial showed that melatonin is effective in improving sleep quality of pediatric patients with AD, but other impacts were not seen. Further testing is needed to determine the effects of melatonin on AD.

Black tea bags are a method of treating facial AD, which is often difficult to treat. One study saw a reduced severity of AD after 3 days of black tea compress use. However, the nickel content of black tea increases risk of nickel hypersensitivity.

Acupuncture can also be used to treat AD, both with and without traditional Chinese herbal medicine. Twice-weekly use of acupuncture improved symptoms in children with AD in a controlled trial. Adverse events are low, but include pain, numbness, or reaction to the contaminants within Chinese herbs. Needle anxiety may also be seen in children.

As increased stress has been associated with impaired skin healing, stress management may improve AD symptoms. One study saw improvements in itch, scratch, sleep disturbance, and mood after hypnotherapy treatment. Biofeedback, progressive muscle relaxation, meditation, guided imagery, and massage may also alleviate symptoms.

Certain regions of Europe might see changes in environment as a source of AD management. Alpine environments have less pollution, dust mites, and aeroallergens than other reasons, benefiting the skin.

Children can live in alpine regions for up to 3 months and receive anti-inflammatory medications to experience alpine climate treatment. Because of the cost and lack of long-term evidence, this is mainly recommended as a short-term treatment for severe AD.

With many options available for treating AD, investigators hope that a balance can be made between symptom control and minimal adverse events. Progress on this goal will continue as more therapies, both prescription and nonprescription, are developed.

Reference

Johnson H, Yu J. Current and emerging therapies in pediatric atopic dermatitis. Dermatol Ther (Heidelb). 2022;12:2691–2703. doi:10.1007/s13555-022-00829-4