Non-pharmacological management of atopic dermatitis

Identification and avoidance of an individual’s trigger factors allows longer periods of remission or total clearance of symptoms. Numerous non-specific physical, chemical and biological factors can irritate the skin and elicit flares in patients with atopic dermatitis. Meanwhile, specific allergens can also promote skin lesions in sensitised patients (Wollenberg et al., 2018).

A selection of common non-specific (blue) and specific triggers (orange) seen in patients with atopic dermatitis.

Figure 18: A selection of common non-specific (blue) and specific triggers (orange) seen in patients with atopic dermatitis (Wollenberg et al., 2018).

Environmental factors such as tobacco smoke and traffic exhaust have been shown to increase the risk of children developing atopic dermatitis and avoidance of them in young children has been introduced into the German S3 guidelines for the prevention of atopic diseases (Schäfer et al., 2014).

Various strategies to avoid allergens have been proposed although with varying levels of evidence. While smooth clothing and avoidance of irritating fabrics and fibres are essential to avoid primary skin irritation other options include (Wollenberg et al., 2018):

  • Mite-proof bedding and pyjamas
  • Pollen avoidance
  • Avoidance of relevant contact allergens e.g. fragrances, preservatives, emulsifiers
  • Primary prevention of food allergy-associated adverse events with exclusive breast milk feeding until 4 months of age
  • Observe a therapeutic diet eliminating those foods that elicited clinical early or late reactions upon controlled oral provocation tests.