You’re all too familiar with the unpredictable nature of atopic dermatitis: Your skin goes from clear to being covered in rashes, weeping sores, and itchy skin, and then back to clear again.
It’s a common pattern for the 31.6 million people in the United States living with atopic dermatitis; 50% of those with the chronic inflammatory skin disease have flares for 8 days every month.
Atopic dermatitis may be a disease that waxes and wanes, but Raj Chovatiya MD, PhD, an assistant professor of dermatology at Northwestern University Feinberg School of Medicine, notes that you should stick to your medication plan – even when you think you may not need to.
“Atopic dermatitis is a chronic disease,” he says. “Staying on top of therapy is important because you're really trying to reduce those flares to have a disease that is much more predictable and well-controlled long-term. So, even if you're doing well now on therapy, that may not be the case a week from now, 2 weeks from now, a few months from now.”
Counting on Consistency
There’s no cure for atopic dermatitis. Instead, the goal of treatment is to control the symptoms by using topical creams, oral medications, and shots. Consistent medication use was linked to a 60% reduction in symptoms after 1 month and more than a 77% reduction after 12 months.
Despite the importance of taking medication to manage atopic dermatitis, it can be difficult to stick with treatment. Among those using topical medications, 70% quit within days of beginning treatment.
Side effects, inconvenience, forgetfulness, a lack of understanding about the importance of medication, and lack of faith in health care providers are among the main reasons that those with atopic dermatitis skip out on their medications. There are varied impacts from not sticking with your treatment plan.
“Atopic dermatitis has highs and lows and peaks and valleys, [and] some patients [who] stop their therapy might do OK for a while,” Chovatiya says. “But most people, when they stop their medication … slowly but surely their symptoms come back. This speaks to the chronic relapsing, remitting nature of the disease.”
Taking medication consistently is important, but that doesn’t mean you should continue using a medication that isn’t working. Chovatiya notes that some people do have atopic dermatitis that gets worse over time, which means that there is no such thing as a one-size-fits-all treatment.
Sticking to the Plan
The most effective treatment for atopic dermatitis is one that takes multiple things into account, from the effectiveness and side effects to your relationship with your health care provider. A good treatment plan can make it more likely that you’ll stick with your treatment.
“The only way you're going to get great treatment adherence is feeling like you are invested in the treatment decision that you've made,” Chovatiya says.
Consider these things when deciding on a treatment option:
Effectiveness: It’s not uncommon for your disease to change over time, which means that a medication that once worked well could become less effective. You might want to quit when a medication isn’t easing your symptoms, but Chovatiya suggests talking to your doctor about switching to another medication that may be better more effective.
“I really try to understand what's going to work for somebody, what's not going to work, and what plan that they can follow,” he says.
Ease of use: Would you rather apply a topical medication? Take a pill? Use an medication that comes as a shot? Many types of medications can treat atopic dermatitis.
If you’re afraid of needles or hate the feeling of creams on your skin, tell your doctor. Finding the method that works best can increase the odds that you’ll stick to treatment.
“These are sort of nuances that end up being important in care, and it really sort of helps to understand what helps with treatment adherence,” Chovatiya says.
Side effects: Common side effects of atopic dermatitis medications include stretch marks, spider veins, glaucoma, acne, cold sores, red and itchy eyes, and reactions where you get your shots. Side effects are a common reason for quitting atopic dermatitis treatment, but quitting can lead to higher rates of relapse.
If side effects aren’t manageable, Chovatiya suggests talking to your doctor about alternative medications; it’s easier to stick with a treatment plan when you aren’t dealing with unpleasant side effects.
Cost: More than one-third of adults in the United States have skipped filling a prescription because of the cost. The mean annual cost of prescriptions for atopic dermatitis treatment is $9,526.
If you’re having trouble affording your medication, you may be tempted to not fill the prescription or to quit taking it. Ask about coupons, drug company assistance programs, nonprofit copay assistance, or other options to make treatment more affordable.
Your provider: More than half of adults with moderate to severe atopic dermatitis feel like their disease is not well-controlled. Creating a therapeutic alliance with your doctor is essential for successfully treating atopic dermatitis and sticking with a treatment plan.
“It's really important at that first visit to establish the relationship [and] to suss out what the best therapeutic alliance is going to be,” Chovatiya says. “I hope that all patients who have atopic dermatitis have a health care provider who is … on the same team to figure out what is going to be the best medication or treatment plan.”
The more strategies you can put in place to help stick with your treatment plan, the easier it will be to keep your atopic dermatitis well-controlled.
Show Sources
Photo Credit: E+ / Getty Images
SOURCES:
National Eczema Association.
Raj Chovatiya MD, PhD, Northwestern University Feinberg School of Medicine, Chicago.
National Health Service (U.K.): “Treatment: Atopic eczema.”
American Academy of Dermatology Association: “Eczema Types: Atopic Dermatitis Diagnosis and Treatment.”
JAMA Dermatology: “Treatment Outcomes Associated With Dupilumab Use in Patients With Atopic Dermatitis.”
Dermatology and Therapy: “Tolerability of and Adherence to Topical Treatments in Atopic Dermatitis: A Narrative Review.”
Clinical, Cosmetic and Investigational Dermatology: “Treatment-resistant atopic dermatitis: challenges and solutions.”
YouGov: “More than one-third of Americans have not filled a prescription because of its cost.”
Dermatology and Therapy: “Costs and Treatment Patterns Among Patients with Atopic Dermatitis Using Advanced Therapies in the United States: Analysis of a Retrospective Claims Database.”
Asthma and Allergy Foundation of America: “Drug Assistance Program.”
