I was compensated by Med-IQ through an educational grant from Pfizer, Inc. to write about the signs, symptoms, and treatments available for eczema/atopic dermatitis in communities of color. All opinions are my own.

The Latest Treatment Options for Eczema & Atopic Dermatitis

Recently I shared a post about What You Need To Know About Atopic Eczema and The Ethnic and Racial Disparities In Care  Today we are discussing the latest treatment options for Eczema and Atopic Dermatitis and what you need to know.

But first, we need to break down the facts of the condition starting with, What Causes Eczema?

What causes eczema? 

• Some patients may have a genetic predisposition that causes their skin to be more reactive, more prone to have allergic factors on the surface of the skin which can trigger redness, scaling, bumpiness, and itch.
• Doctors often consider the “atopic triad” – asthma, seasonal allergies, and atopic dermatitis –in patients with atopic dermatitis, and many patients often have a family member with one of those symptoms.

For my daughter, I never thought to ask my family members if they have ever been diagnosed with Eczema or Atopic Dermatitis. She had the “Atopic Triad” and I had no idea that these symptoms were a direct correlation to her Eczema. Knowing more about your family history may help you to have a more open, detailed conversation with your doctor about your condition.

This condition affects patients and families in ways you may have never thought of. For example, if a person has more severe atopic dermatitis it can have a huge effect on their quality of life. Not just for the patient but for the patient’s family as well. Believe it or not, It can affect every aspect of a patient’s life. Including sleep patterns, ability to focus in school or at work, mental health, and stress levels. This is especially relevant right now–in the middle of a global pandemic–when people’s stress levels are higher.

In addition, there is an economic impact on eczema for many patients. Because over-the-counter (OTC) medicines and treatments can be really expensive. Additionally, some patients cycle through many various treatments, which can be both frustrating and expensive. Not to mention, these options may be ineffective in some patients. Although it may be tempting, self-diagnosing and self-treating may not be the best thing to do with this condition.

With my daughter, I thought that eczema was only common in babies and children. But it can also occur in teens and adults. What I learned about this condition is that there are differences that you should be aware of regarding skin tone and atopic dermatitis.

Recently Jeannette Kaplun (Hispana Global) hosted a Facebook Live Interview with Dr. Alexis. The conversation was jammed packed with valuable information on treating eczema in skin of color, including the latest treatment options and how best to utilize telemedicine to access a skin care professional. You can watch the session here.

If you were to search the internet to find pictures of eczema or atopic dermatitis for pigmented skin tones, you probably won’t have much luck. Atopic dermatitis presents differently on pigmented skin tones and can appear grey or purplish or darken affected skin. And once it resolves, it can leave pigmentary changes, either darker or lighter pigmentation for weeks or months. This presents an additional impact on patients of color. The differences in the presentation can also contribute to delays in diagnosis.

There is also a type of eczema, called Nummular Eczema that is often misdiagnosed as “ringworm” in patients of color. It presents as circular rashes, and it can occur along with atopic dermatitis.

When You Need To Seek Treatment 

If you are like me, you probably feel like you can manage this condition on your own. But as I mentioned in my previous post, What You Need To Know about Atopic Eczema and The Ethnic and Racial Disparities In Care I tried everything to help my daughter get some relief from her eczema. It wasn’t until it kept coming back no matter what I changed that I decided to seek medical treatment for her condition.

Atopic Eczema is a chronic condition, and it does not just “go away”; it can actually increase the risk of infections and it can affect patients’ ability to function in their daily lives. So, if you are a parent of children or you have atopic eczema, I encourage you to seek treatment.

If you are an adult, you may choose to see a dermatologist specifically about treating eczema. If you are a parent you can take your child to their pediatrician for atopic dermatitis treatment, even if their child has moderate-to-severe eczema. However, if a pediatric patient isn’t getting better, the parents should consider making an appointment with a dermatologist.

Remember when it comes to your health you are the best advocate. Speak up and let them know that the treatment is not working, and you would like a referral to a dermatologist to help get answers for your condition. The goal for treating atopic dermatitis is to have the ability to navigate life by reducing the frequency of flare-ups instead of quick fixes when these flare-ups occur.

If you are not satisfied with your treatment, there are experts with experience in treating dermatologic conditions in skin of color (please see links in the RESOURCES section below)

Now let’s dive into skincare and treatments

You’re probably wondering what you can do to treat your skin so let’s get into skincare and treatments.

Basic Skin Care:

The first step on the treatment ladder is gentle skin care treatments. You want to use soaps and cleaners that are oil-based, do not contain preservatives, and moisturize the skin. When it comes to caring for your skin you want to identify and avoid possible irritants and allergens that can trigger or aggravate disease flares which is important but also challenging.

Topical therapies (mild or moderate atopic dermatitis):

The next step on the treatment ladder is often short-term use of topical corticosteroids as long-term use is not recommended due to an increased risk of side effects. Corticosteroid-sparing therapies are also available if basic management strategies do not provide relief; these can be used longer-term and are recommended for sensitive body sites such as the face or diaper area. These include crisaborole (Eucrisa®), topical calcineurin inhibitors such as tacrolimus ointment (Protopic®) and pimecrolimus cream (Elidel®), and generic options.

For patients that have more severe atopic dermatitis moving up the treatment ladder may be necessary.

Systemic therapies (moderate to severe atopic dermatitis):

• Nonspecific immunosuppressants such as systemic corticosteroids and other immunosuppressing therapies may be prescribed; however, their use may be limited due to side effects, the potential for rebound flares, or the need for laboratory work.
• New systemic agents are emerging that target the underlying causes of atopic dermatitis, including the factors that cause itch and inflammation. Currently, one injectable biologic is FDA approved for use in patients aged 6 years and older, and other targeted agents that can be taken orally are currently in development.
• Systemic therapies may also be augmented by topical medications.

Because atopic dermatitis is a chronic condition, a formal written plan or “Eczema Action Plan” can help patients follow their recommended management plan. If treatments are not working despite following the management plan, a treatment change may be needed; it is important to seek care from a skin care provider.

If needed, consider seeking help from a dermatologist, pediatric dermatologist, or eczema specialist who may be more comfortable moving up the treatment ladder. Patients should look for a healthcare provider who is a partner with them in their treatment journey. One that asks for their preferences, discusses their prior experiences. Also, who will partner with them to develop an Eczema Action Plan.

How Does Covid-19 Impact Your Treatment Options? 

With the increased use of harsh hand sanitizers and increased hand-washing, it may further irritate skin and eczema rashes. Now more than ever it may seem challenging to see a provider to help you treat this condition. Due to the healthcare practices not accepting as many appointments it can make seeing a doctor more challenging. I have good news!

You may be wondering how does receiving treatment work in the middle of a pandemic. Telemedicine is an effective, alternative way to ensure easy and timely visits.

For patients of color, eczema can lead to light or dark color spots, or hypopigmentation. By continuing their treatment plan, and not allowing for disruptions in care due to the pandemic, patients can maintain better control of their disease, minimize the hypopigmentation, and reduce the risk of flares.

Telemedicine is an effective, alternative way to ensure easy and timely visits, especially now when the need for social distancing has led to healthcare practices limiting appointments―which makes seeing a doctor more challenging.

To optimize a telemedicine visit, follow these tips:

• Before making an appointment, check with your insurance provider to make sure telemedicine visits are covered.
• Take photos of the condition before the visit and send the images to the doctor in advance because high-resolution images are better quality than video.
• Collect any medicines in advance of the appointment and have them nearby.
• Come prepared to discuss any family history of allergies and asthma.
• Find a quiet area and make sure there is internet access.
• Because lighting is very important for dermatology visits, patients should place the light in front of them and face the window; windows should not be behind them.
• Patients should know their cleansing and moisturizing routines.

To find a doctor who treats skin of color, patients can check out the Skin of Color Society or American Academy of Dermatology website and search for areas of specialization, including skin of color.

Eczema and atopic Dermatitis is a big deal. I want to let you know that Med-IQ is conducting an anonymous survey and I would appreciate your input.

( Please note: The survey contains links to external sites.)

Any such links are provided as a convenience and for educational purposes only. They are not intended as medical or legal advice, nor are they endorsements of any organization.)

The survey will take less than 10 minutes to complete. Survey responses are shared only in aggregate. Your responses to these survey questions will provide Med-IQ with important information about your experiences with atopic dermatitis. Which will help us develop future educational initiatives.

Once you’ve completed the survey, you will have the option of providing your email address to be entered into a drawing administered by SOMA Strategies to win 1 of 10 $100 VISA gift cards.

If you choose to enter, your email address will be used only to randomly draw the winners and notify them of their prize, and to send a follow-up survey as part of this same initiative.

As promised, below are the links to resources on eczema and atopic dermatitis.

Resources:

Links to external sites are provided as a convenience and for informational purposes only. They are not intended and should not be construed as legal or medical advice, nor are they endorsements of any organization. Med-IQ bears no responsibility for the accuracy, legality, or content of any external site. Contact the external site for answers to questions regarding its content

Additional Resources

• National Eczema Association
  • Eczema treatments: https://nationaleczema.org/eczema/treatment/
  • Eczema in skin of color: https://nationaleczema.org/eczema-in-skin-of-color/
• Telemedicine and Teledermatology
  • Preparing for a telemedicine visit:
    • aad.org/public/fad/telemedicine/telemedicine-prepare-appointment
    • skinsight.com/health-topics/teledermatology-basics-making-the-most-of-a-new-situation
  • Photographing your skin for a teledermatology appointment:
    • skinsight.com/health-topics/teledermatology-tips-photographing-your-skin-for-your-virtual-visit
    • https://info.visualdx.com/l/11412/2020-03-31/6h4hdz
  • Skin of Color Society (org)
  • American Academy of Dermatology Eczema Resource Center (aad.org/public/diseases/eczema)
  • National Medical Association (nmanet.org/)
  • Hilton L. Eczema more common in black patients [insights from Dr. Andrew Alexis]. Dermatology Times. November 24, 2019. dermatologytimes.com/view/eczema-more-common-black-patients
  • Penn Medicine News. Hispanic and Black Children More Likely to Miss School Due to Eczema Than White Children. May 22, 2019. pennmedicine.org/news/news-releases/2019/may/hispanic-and-black-children-more-likely-to-miss-school-due-to-eczema-than-white-children.
  • American Academy of Dermatology Atopic Dermatitis Clinical Guideline (aad.org/member/clinical-quality/guidelines/atopic-dermatitis)

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