Atopic dermatitis (AD), the most common form of eczema, can be treated in a number of different ways. Options include moisturizers, over-the-counter and prescription topical treatments, systemic medications, and phototherapy — often in combination.
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But how can people with AD know whether their treatment plan is working?
AD can wax or wane over time, so treatment success doesn’t always mean your symptoms will disappear completely or for good. Instead, signs such as less itching, calmer skin, and fewer or less-frequent flares can indicate that your treatment is helping.
Here’s a look at six changes that may suggest your treatment is moving in the right direction.
1. You’re Itching Less
Itch is one of the most common symptoms of AD — but it may be one of the first to respond to treatment, too, says Julie Van Onselen, a dermatology nurse adviser for the nonprofit organization Eczema UK in Oxford, England.
“It tends to be that itch is one of the first things to go, and then the skin gradually improves,” Van Onselen says.
Studies of newer AD treatments suggest that itching can lessen within days after therapy begins. Some research suggests early itch relief can be a predictor of clear skin 12 to 24 weeks later.
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Dermatologists say that itch is the most burdensome symptom for people with AD.
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An improvement in this area can lead to other good health outcomes: Research suggests that itch affects five different aspects of quality of life, including sleep, emotional status, physical function, social and sexual activity, and productivity.
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Your dermatologist may track itch using tools, such as the Peak Pruritus Numerical Rating Scale (PP-NRS), which asks you to rate your itchiness on a scale from 0 to 10, says Renata Block, PA-C, a physician assistant and an assistant professor at Rush University in Chicago, where she specializes in dermatology and inflammatory skin conditions. A drop of about three to four points is often reported as a meaningful improvement by people with the symptom.
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“People can also rate themselves between visits and share with their clinician,” Block says.
2. Your Skin Feels Smoother and Less Inflamed
Less scaling, cracking, roughness, or inflammation can also suggest that active eczema is coming under better control, says Chris Adigun, MD, a dermatologist in private practice in Chapel Hill, North Carolina.
Try not to rely solely on your skin’s appearance. It can be misleading because pigmentation and dark patches may linger even after the active disease has calmed down, she says.
Focus instead on your skin’s texture. “Treatment endpoint with a topical medicine is when you close your eyes and rub your hand over the affected area, and it’s just smooth and feels like the surrounding skin,” Dr. Adigun says. “Oftentimes, it will take months for the discoloration to correct,” she says.
The extent of eczema can be measured by clinicians using the Eczema Area and Severity Index (EASI), which looks at how much of the body is affected and the severity of symptoms like redness and scratching, or the Patient‐Oriented Eczema Measure (POEM), which captures patient-reported symptoms, such as bleeding, cracking, or flaking.
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3. Your Flares Are Becoming Less Severe
Effective treatment doesn’t mean you’ll never have another flare, but you may notice a decrease in their severity and an increase in the time between them, Adigun says.
“The goal is a significant decrease in flare severity, [in] intensity and duration, though it is never perfect as there are many triggers in AD,” Block says.
Consider whether your AD pattern is changing. You may notice treatment is helping as a flare might be less intense, last for less time, or occur after a longer stretch of better-controlled symptoms.
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Block suggests recording symptoms in a journal or taking photos of your skin to help you and your clinician recognize gradual changes.
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4. You’re Sleeping Better
Itching from AD can be especially disruptive at night, so better sleep can be another meaningful sign that treatment is helping.
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You may fall asleep more easily, wake up less often to scratch, or feel less drowsy in the morning, Van Onselen says.
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“With less itch, you’re able to sleep better, eczema may feel less painful or sore and less bothersome,” she says.It can be beneficial for the whole family when children’s sleep improves. “When we think about our kiddos [who have AD], it affects the parents’ sleep as well,” Block says. One small study of 23 children and their mothers found that both parents’ and kids’ sleep improved when their little ones’ AD was managed with topical therapy. Caregivers reported having more energy, improved mood, and getting over an extra hour of sleep.
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5. You’re Returning to Activities You Used to Avoid
Another key sign of improvement may have little to do with what you see in the mirror, Van Onselen says. You may notice your mental health and quality of life improving.
“It can look like being able to go out and do things you perhaps couldn’t do when you had an eczema flare, like sports or swimming … or even going back to work or school after taking time off,” Van Onselen says. “You’re restoring your life back to normal and doing the things eczema stopped you from doing.”
It’s an important area to take stock of. People with AD are at a greater risk of depression and anxiety than people without the condition, because things like sleep disturbance, symptom unpredictability, lifestyle restrictions, missed activities, and social stigma, among other factors, add a mental health burden to the disease.
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6. You’re Getting Closer to Your Treatment Goals
There isn’t a one-size-fits-all approach to measure AD treatment success, Block says. Some people are working on taming itchiness while others may be focused on building a personalized treatment plan or returning to their social life.
“Ideally, any good clinician would set goals with patients and would ask patients what you want to achieve,” Van Onselen says. Goals can be practical, such as finding a moisturizer that works for daily usage, or getting back to a hobby that eczema has kept you from doing, she says.
If your symptoms aren’t improving as expected, contact your dermatologist instead of changing your treatment on your own. Different therapies can work on different timelines, and your doctor can determine whether you need more time or whether your treatment plan should be adjusted, Van Onselen says.
