OTCs Today

Mary Warner

Atopic dermatitis, a form of eczema that causes dry, itchy, and inflamed skin, is common in young children but can occur at any age. It’s a chronic condition that tends to flare after triggers, which differ from one patient to another. It can be irritating, but not contagious, and can be treated with nonprescription topical therapy. Dry skin, although usually not as chronic as atopic dermatitis, can be problematic, especially among older adults, and can be treated with nonprescription emollients.

Atopic dermatitis symptoms can appear anywhere on the body and vary widely from person to person. They may include dry, cracked skin; itchiness; rash; small raised bumps; oozing and crusting; thickened skin; and raw skin from scratching. Atopic dermatitis often begins before age 5 and may continue into the teen and adult years. It can flare and then clear up for a time, even several years, before reoccurring. Atopic dermatitis can be caused by a genetic variation or by excess Staphylococcus aureus on the skin, which displaces helpful bacteria and disrupts the skin’s barrier function. Complications may include development of asthma and hay fever, food allergies, and skin infections from repeated scratching.

Because atopic dermatitis has various triggers, avoidance of those triggers is key to successfully managing the condition. Common triggers include airborne allergens (e.g., dust mites, cat dander, molds, grass, ragweed, pollen); airborne irritants (e.g., tobacco smoke, air pollution, and traffic exhaust); dyes and preservatives in soaps, detergents, and scrubs; food allergens (e.g., eggs, milk, peanuts, soy, wheat, or nuts); tight-fitting clothes; and weather changes, including exposure to heat and cold or low humidity. Triggers vary by patient, so it’s important that patients try to avoid them as much as possible. Following identification of triggers, self-treatment can begin.

Moisturizers

The goals of self-treatment for atopic dermatitis are to stop the itch–scratch cycle, maintain skin hydration, avoid triggers, and prevent secondary infections. The use of moisturizers is standard of care for atopic dermatitis because maintaining skin hydration and the skin barrier is key to successful management. Moisturizers, especially those containing emollients, should be used at least twice daily to keep skin soft and pliable. 

Moisturizers come in a variety of formulations, including butters, gels, oils, ointments, lotions, and creams. Ointments are recommended due to their high lipid content and ability to retain moisture but are inappropriate for use on oozing atopic dermatitis lesions because they may not allow the lesions to dry and ultimately heal. They often contain petrolatum, making them feel greasy, and they may not be effective in very warm weather.

Lotions and creams are typically oil-in-water emulsions that are less greasy than ointments. They help alleviate  itchiness because of their cooling effect as water evaporates from the skin surface. While lotions may be preferred in milder cases of dryness they can have a drying effect. Butters, while soothing, can be difficult to spread. And gels, which are often preferred because of their cooling effect, can also be difficult to spread evenly.

Corticosteroids

In cases in which moisturizers don’t  yield satisfactory results, topical corticosteroids can be used. Hydrocortisone (0.5% or 1%) is currently the only corticosteroid available without a prescription for the topical treatment of dermatitis. Although its exact mechanism is unknown, hydrocortisone most likely suppresses cytokines involved in the development of inflammation and itching. It should be applied sparingly twice daily to affected lesions before application of moisturizers.

For mild atopic dermatitis, hydrocortisone cream is often preferred by patients, but ointments generally provide better results with chronic, non-oozing lesions. However, ointments should be avoided if the lesions are weeping, and all hydrocortisone products should be avoided if the skin is infected, open, or cracked. Hydrocortisone is safe when used as directed for the short term, but overuse may cause decreased effectiveness and adverse effects, such as thinning skin.

Dry skin

Dry skin, like atopic dermatitis, is more prone to itching, inflammation, and development of secondary infections. Moisturizers should be applied several times a day to maintain skin hydration. Dry skin responds minimally to topical corticosteroid therapy, although short-term (7 days or fewer) use may reduce redness and itching.

What to tell your patients

Instruct patients how to properly apply topical hydrocortisone products, using the smallest amount possible only on affected lesions and thoroughly rubbing in the product. Caution patients that scratching lesions may result in skin infections that necessitate antibiotic treatment. Finally, advise patients that if self-treatment is not effective, they should seek advice from their primary care physician in case prescription options are needed.

For more information, see the  “Atopic Dermatitis and Dry Skin” section in APhA’s Handbook of Nonprescription Drugs, available in the bookstore on pharmacist.com or in APhA OTC in PharmacyLibrary (www.pharmacylibrary.com).  ■