How to Manage Atopic Dermatitis Pain

“I think that the first thing that comes to mind when we talk about eczema is the itch,” says Bruce Brod, MD, a clinical professor of dermatology at the Perelman School of Medicine at the University of Pennsylvania in Philadelphia. “But pain is also a relatively common symptom of atopic dermatitis that is often underrecognized. I have found that anywhere from half to two-thirds of patients with atopic dermatitis will experience pain.”

For most people with atopic dermatitis, standard therapies to relieve eczema will help reduce pain. “It’s really just treating the underlying eczema with the same medicines you would use if it were just itchy,” says Matthew Lewis, MD, MPH, a clinical associate professor of dermatology at Stanford University in California.

Medications and therapies with proven track records include:

• Creams and Ointments You can discuss many prescription anti-inflammatory topical treatments with your dermatologist. For example, corticosteroid (steroid) cream or ointment can reduce itchiness and heal the skin. Some people benefit from creams containing drugs called calcineurin inhibitors, such as tacrolimus (Protopic) and pimecrolimus (Elidel), which help tamp down the overactive immune systems that cause eczema inflammation.
• Antibiotics to Fight Infection Topical antibiotics (applied to the skin), such as fusidic acid or mupirocin, and tablet antibiotics, such as flucloxacillin, can help eliminate infections. Antiseptic soaps and bath additives (such as a bleach bath) can kill bacteria.
• Systemic Anti-Inflammatory Drugs Pain relievers such as nonsteroidal anti-inflammatory drugs can help. More severe cases may require an oral corticosteroid such as prednisone.

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• Injectable Biologics Injectable drugs like dupilumab (Dupixent) are sometimes prescribed to atopic dermatitis patients who do not respond well to other treatments

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• Wet Dressings A combination of topical corticosteroids covered with wet bandages can mitigate inflammation and pain in the affected areas
• Light Therapy Also called phototherapy, this treatment uses different wavelengths of ultraviolet light to reduce inflammation and itchiness
• Mental Health Counseling and Behavior Modification Patients can learn ways to manage thoughts and behaviors that may lead to excessive itching and increased pain

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In the Journal of Allergy and Clinical Immunology study cited above, Dr. Silverberg and colleagues found that patients with mild eczema were more likely to have pain related to scratching, while those with moderate or severe eczema felt more constant discomfort and aching due to inflammation.

The researchers noted that for most eczema patients with pain, the issue was linked to open parts of the skin caused by scratching (27 percent) and with fissures in the skin (27 percent). About one-quarter said they were hurting from inflamed skin. Just 10 percent reported a burning sensation caused by topical medications like steroid creams.

Karan Lal, DO, a dermatologist and the chairman of the social media committee for the Society for Pediatric Dermatology, says that when inflamed skin opens up, exposed nerves increase the risk of pain as well as infection.

“I think a lot of people who get pain have more active eczema that is inadequately controlled and have chronic disease in the common eczema sites,” says Lal.

One Young Patient’s Battle

Dr. Lal described the experience of one of his pediatric patients who was highly active in sports and had severe eczema behind his knees that resulted in extreme pain. The 10-year-old’s pants rubbed against the affected areas of his legs, staining his jeans with blood and making the pain even worse.

Lal treated the boy with ointments and a topical steroid medication, and he instructed the parents to make sure their son’s legs were wrapped and lubricated at all times. Lal also prescribed Tylenol for pain relief.

“It was really aggressive management — he had to do these wraps on weekends when he could stay at home and rest and not move around a lot,” said Lal. “It took about nine days or so to clear him up, but it helped a lot.”

“Pain can impact mental health, lead to sleep disturbances, and reduce the overall quality of life,” says Dr. Brod. “It can interfere with a patient’s ability to work and socialize, and that can lead to depression and anxiety.”

Dermatologists may counsel patients directly or refer them to a therapist for more extensive help.

“Although it’s typically not life-threatening, pain from eczema has the real ability to ruin somebody’s life,” says Brod. “There’s also optimism in the fact that there are treatments that can control this and return patients to a much better quality of life. If you’re experiencing severe pain, it’s best to visit a board-certified dermatologist, who is the best person to be able to treat this.”

• Pain is an underrecognized but serious symptom that affects many people with atopic dermatitis due to factors like scratching and cracked or broken skin.
• Fortunately, many treatment options help manage symptoms like pain, including topical creams or ointments, over-the-counter pain relievers, higher-strength oral or injectable systemic drugs, and more.
• Speak with your healthcare professional before trying any pain management for atopic dermatitis.