Atopic Dermatitis Treatment in Ankara, Turkey

Atopic dermatitis treatment is applied to control chronic inflammatory reactions occurring in the skin and to alleviate symptoms such as itching and dryness. The basis of treatment includes strengthening the skin barrier, reducing inflammation, and eliminating triggering factors. The process should be managed with a multidisciplinary approach.

The use of moisturizers is the most important step in atopic dermatitis treatment. Keeping the skin constantly moisturized breaks the itch cycle by reducing dryness. Barrier-repair creams that do not contain perfume or alcohol are preferred. Regular use increases the effectiveness of drug treatments and prevents flare-ups.

Topical corticosteroids and calcineurin inhibitors are commonly used for inflammation control. These medications reduce redness, itching, and eczema plaques. In moderate and severe cases, systemic treatments, phototherapy, or biological agents may be applied. Treatment should be individualized according to the severity of the disease.

Control of environmental factors is of great importance in atopic dermatitis. Avoiding allergens, wearing cotton clothes, and managing stress reduce flare-ups. Regular dermatology check-ups and patient education increase treatment success and significantly improve quality of life.

What Is Atopic Dermatitis?

Atopic dermatitis is an inflammatory skin disease characterized by chronic and recurrent features, progressing with symptoms such as dryness, itching, redness, and eczema-like signs on the skin. It usually begins in childhood but can be seen at any age. Genetic predisposition, immune system disorders, and environmental factors play a role in the development of the disease.

Why Does Atopic Dermatitis Occur and What Does It Do to Our Skin?

At the basis of atopic dermatitis lie two main interrelated problems.

The first is a defect in the skin’s protective “barrier” function. You can think of healthy skin as a solid “brick wall” that protects us against threats coming from the outside world. If the bricks of this wall are skin cells, its mortar is the natural oils (lipids and ceramides) and proteins produced by the skin itself. In skin with atopic dermatitis, however, this “mortar” is missing. The wall virtually “leaks.” Because of this leaking wall, the skin cannot retain its moisture, rapidly loses water, and becomes excessively dry.

The second is the overreaction of the immune system. Allergens, irritants (detergent, perfume, etc.), and microbes entering through the leaking wall (that is, skin with a damaged barrier) unnecessarily put the immune system on alert. The immune system gives an exaggerated inflammation (inflammatory) response against these substances that may actually be harmless. This inflammation manifests itself as redness, swelling, thickening, and that never-ending itch.

The aim of treatment is to target these two main problems at the same time: both to repair the “leaking wall” (barrier treatment) and to extinguish the “fire of the immune system” (anti-inflammatory treatment).

The Cornerstone of Atopic Dermatitis Treatment: Why Is Repairing the Skin Barrier So Important?

Although patients usually focus on medicated creams that stop inflammation during flare-up periods (such as cortisone), the real basis of atopic dermatitis management and the key to long-term success is the continuous repair of the skin barrier. This is not just supportive care but a high-level therapeutic intervention in itself.

If your skin barrier is weak, even if you suppress a flare-up with anti-inflammatory creams, the skin is still defenseless against external factors. Allergens and irritants continue to seep in and trigger a new flare-up shortly afterward. This creates a cycle of “putting out the fire and starting again.”

Continuous and proper moisturization breaks this vicious cycle. A strong barrier reduces the need for cumulative use of anti-inflammatory drugs (cortisone creams) and decreases the frequency and severity of flare-ups.

How Should the Right Moisturizer (Emollient) for Eczematous Skin Be Chosen?

Moisturizers are the primary mainstay of atopic dermatitis treatment. These are not cosmetic products but barrier-repair products with the quality of “medicine” that restore the water and oil (lipid) the skin has lost.

Things to consider when choosing a moisturizer:

• Dense, oil-based creams (lotions are generally insufficient).
• Ointments (contents such as Petrolatum, namely petroleum jelly, are the most effective in trapping water in the skin).
• Formulations containing ceramide, urea, or glycerin.
• Fragrance-free and hypoallergenic products (perfume is one of the biggest triggers for eczema).

In particular, some formulations containing “colloidal oatmeal” (oatmeal extract) have been observed to help maintain the skin’s healthy pH balance and improve the balance of beneficial bacteria on the skin surface (microbiome).

Moisturizers should be generously applied to the whole body every day, at least twice a day, preferably immediately after bathing, whether there is a flare-up or not.

How Should Bathing Be Done for Atopic Dermatitis and What Is the “Soak and Seal” Method?

Cleaning eczematous skin requires a delicate balance. The aim is to cleanse the skin of irritants and allergens without stripping away the skin’s little remaining natural oils.

The following should be considered while bathing:

• Lukewarm water (definitely not hot).
• Short baths not exceeding 5 to 10 minutes.
• Soap-free, fragrance-free, hypoallergenic cleansers suitable for the skin’s pH (syndets).
• Gentle cleaning without a scrubber.
• After bathing, drying the skin by “gently patting” rather than “rubbing” with a towel.

“Soak and Seal” Method:

This is one of the most critical steps of this treatment. A bath or shower allows the skin to be filled with water. The aim is to trap that water in the skin before it evaporates.

After bathing, the skin is left slightly damp.

Within the first 3 minutes after getting out of the bath (while the skin is still damp), an intensive moisturizer (or if there is a flare-up, first the medicated cream, then the moisturizer) is applied to the whole body.

This “sealing” process prevents water from evaporating rapidly and ensures that moisture remains in the deeper layers of the skin.

How Should Cortisone Creams (TCS) Be Used During Atopic Dermatitis Flare-Ups?

During flare-up periods, that is, when the skin is red, raised, and intensely itchy, moisturizer alone is not enough. It is necessary to suppress the inflammation, that is, the overreaction of the immune system (the fire). At this point, “topical corticosteroids” (TCS), namely cortisone creams, come into play.

Cortisone creams have been the “gold standard” treatment in atopic dermatitis flare-ups for more than 40 years. They suppress inflammation rapidly and effectively. They are generally used once or twice a day for the period determined by your dermatologist (usually 1-2 weeks) to achieve healing.

How Does “Cortisone Fear” (Corticophobia) Affect Eczema Treatment?

A common “fear of cortisone” (corticophobia) is observed among patients and parents. The most common concerns are skin thinning, visible veins, or systemic side effects (such as growth retardation).

This fear is one of the biggest obstacles to treatment. Patients either do not use the cream at all, apply too little, or stop it earlier than the doctor recommends. Inadequate treatment leads to eczema not being brought under control, continued itching, deterioration in sleep quality, and actually the need for stronger treatments in the long term.

It has been proven in modern dermatology practice that these fears are unfounded. Dermatologists adjust the strength (potency) of the cream according to the body area (low for the face, stronger for the back).

One of the most important innovations is “proactive” or “weekend” treatment. After the flare-up is brought under control, instead of stopping the cream completely, it is applied only twice a week (for example Saturday-Sunday) to the previously problematic areas. It has been proven that this strategy prevents new flare-ups and does not carry a risk of skin thinning or systemic side effects in the long term.

What Is the ‘Fingertip Unit’ (FTU) Method for Cortisone Creams?

The most scientific way to overcome cortisone fear and use the correct dose is the “Fingertip Unit” (FTU) method. This standardizes how much cream should be applied.

What Is 1 FTU (Fingertip Unit)?

It is the amount of cream squeezed from the tip crease (from the base of the nail) to the fingertip of an adult’s index finger (approximately 0.5 grams).

This method provides a clear guide instead of ambiguous measurements such as “pea-sized.” The approximate recommended FTU amounts according to body regions are as follows:

• Face and Neck: 2.5 FTU
• One Arm (From Shoulder to Wrist): 3 FTU
• One Leg (From Hip to Ankle): 6 FTU
• Trunk (Front or Back): 7 FTU
• One Hand (Both Sides): 1 FTU

Most patients use much less cream than this measure and therefore do not get an adequate response from treatment. Correct dosing is critical for the success of treatment.

Are There Non-Cortisone Medicated Creams (TCI) for Atopic Dermatitis?

Yes. Especially for sensitive areas where concerns about cortisone side effects exist (face, eyelids, neck, armpits), cortisone-free creams called “Topical Calcineurin Inhibitors” (TCI) (with active ingredients Tacrolimus or Pimecrolimus) are available.

These creams suppress the T cells of the immune system that produce inflammation through a different pathway. Their main advantages are:

• Unlike cortisone, they do not cause skin thinning (atrophy).
• They are ideal for long-term use on sensitive areas such as the face.
• They are very effective in reducing itching (usually within 4 days).
• They can be safely used in proactive (maintenance) treatment.

Very extensive follow-up studies conducted with the widespread worldwide use of these creams for more than twenty years have not shown a causal increase in skin cancer or other cancer types with the use of these creams. Dermatologists safely recommend these treatments knowing this current safety profile.

What Are the New-Generation Cortisone-Free Creams in Eczema Treatment?

In recent years, new-generation cortisone-free creams that more specifically block the inflammatory mechanisms of atopic dermatitis have also been developed. The American Academy of Dermatology’s (AAD) 2025-focused updates emphasize the importance of these agents:

Topical PDE-4 Inhibitors (Ex: Roflumilast, Crisaborole): These creams block an enzyme called PDE-4, which plays a role in the production of inflammatory signals inside the cell.

Topical AhR Agonists (Ex: Tapinarof): These creams suppress inflammation by binding to a receptor that activates the skin’s own natural anti-inflammatory pathways.

These new agents offer steroid-free, targeted, and safe options for mild and moderate eczema.

How Can Endless Atopic Dermatitis Itching Be Managed?

Itching is the most disturbing symptom of atopic dermatitis and the one that most impairs quality of life. Itching creates an “itch-scratch cycle”: as the skin itches, the person scratches; the scratched skin is damaged more, its barrier is further disrupted, and it becomes more inflamed; this causes more itching.

The most effective way to stop itching is to treat the underlying inflammation. As cortisone creams, TCIs, and new systemic treatments reduce inflammation, itching also decreases.

Some supportive methods to manage itching during flare-up periods:

• Applying a cold, damp cloth to the itchy area.
• Keeping the skin constantly moisturized (dry skin always itches more).
• Keeping the nails short and blunt.
• Wearing cotton gloves to prevent nighttime scratching (especially in children).
• TCI creams containing tacrolimus (they stop itching quickly).
• Applying “Wet-Wrap Treatment” in severe cases.

Do Allergy Pills (Antihistamines) Help with Eczema Itching?

This is a frequently asked question by these patients. Itching in hay fever or hives is caused by a chemical called “histamine,” and allergy pills work by blocking this histamine. However, atopic dermatitis itching is much more complex, and histamine does not play the primary role.

Therefore, standard (second-generation, non-sedating) allergy pills have little or no objective effect on reducing eczema-related itching.

However, old-type (first-generation, sedating) antihistamines may be prescribed mainly because of their calming and sleep-inducing effects. Rather than directly stopping itching, these medications help the patient break the itch-scratch cycle and fall asleep, especially at night.

Why Is Eczematous Skin Prone to Getting Infected?

Skin that has a damaged barrier, is cracked, and has been injured by scratching is vulnerable against bacteria and viruses. In particular, a bacterium called “Staphylococcus aureus” (Staphylococcus) is found on the skin of patients with atopic dermatitis at much higher rates than in healthy individuals:

This bacterium may cause the skin to become even more inflamed and flare-ups to worsen. Sometimes these bacteria also lead to active infection. Signs of active bacterial infection are:

• Yellow-green discharge coming from the skin.
• Honey-colored crusting.
• Locally increased pain, swelling, and warmth.
• Sometimes fever or weakness.

If these signs are present, antibiotic cream or oral antibiotic treatment may be required. However, routine antibiotic use is not recommended in non-infected eczema.

What Is a “Bleach Bath” in Atopic Dermatitis and Is It Safe?

Although this method may sound frightening, it is an extremely safe and effective “decontamination” (reducing microbial load) strategy when applied correctly.

The aim is not to “clean” the skin but to reduce the load of harmful bacteria (especially Staphylococcus) on the skin surface, thus normalizing the microbiome and calming flare-ups.

• Safety: The dilution ratio in this bath is very high; the chlorine level in the water is similar to the chlorine level in an average swimming pool. It does not irritate or burn the skin.
• Application: Generally, half a tea glass (approximately 100-150 ml) of standard, additive-free (fragrance-free, non-concentrated) household bleach is added to a standard tub of lukewarm water.
• Protocol: The patient stays in this water for about 10 minutes (with the face remaining outside), then rinses off and the “Soak and Seal” method (moisturizer) is applied immediately. This is usually done 2-3 times a week.

What Is Light Therapy (Phototherapy) for Atopic Dermatitis When Creams Are Not Enough?

In moderate-to-severe cases where topical treatments (creams) cannot provide sufficient control or where the eczema is very widespread, “Phototherapy” (Light Therapy) is recommended as a second-line treatment.

In this treatment, the harmful rays in sunlight are filtered out and only the “Narrowband UVB” (NB-UVB) rays, which have a healing effect, are used. This is not a solarium treatment. The patient receives this light in a special cabin for durations that start with seconds and are gradually increased.

NB-UVB rays suppress the excessive activity of the skin immune system cells (T cells) and reduce inflammation. It is applied in 2-3 sessions per week and is an effective method that reduces the need for cortisone (provides corticosteroid sparing).

Is There a Cancer Risk in Phototherapy for Eczema Treatment?

Patients’ biggest concern about phototherapy is usually the risk of skin cancer. However, recent follow-up studies involving large populations have clearly shown that Narrowband UVB (NB-UVB) phototherapy is not associated with an increased risk of melanoma or non-melanoma skin cancer in patients with atopic dermatitis.

Known side effects of phototherapy are:

• Redness similar to sunburn (prevented with dose adjustment).
• Dryness in the skin (plenty of moisturizer is required).
• Signs of accelerated skin aging in the long term (freckling).

Which Treatments Are Used for Very Severe Atopic Dermatitis?

In severe and resistant cases of atopic dermatitis where phototherapy has also failed or cannot be applied, systemic (oral) medications that suppress the immune system more broadly are used. These are known as “traditional systemic immunosuppressants”:

• Cyclosporine
• Methotrexate
• Azathioprine

Cyclosporine is a very powerful and fast-acting medication and is used to quickly bring severe flare-ups under control. However, due to its long-term side effects (kidney, blood pressure), it is generally used to provide short-term control or as a “bridge” to safer long-term treatments. These medications are strong treatments that require close physician monitoring with blood tests.

The Revolution in Eczema Treatment: What Are Biological Agents (Injections)?

A revolution has taken place in atopic dermatitis treatment over the last 10 years. The reason for this revolution is “biological agents” that very specifically target the immune system problem at the root of the disease.

Biological agents are laboratory-produced “smart” proteins (monoclonal antibodies). Instead of broadly suppressing the body’s immune system like Cyclosporine, they capture and block only the specific signaling molecules (cytokines) that cause inflammation with a lock-and-key compatibility.

The main biological agents approved for atopic dermatitis are:

• Dupilumab: It blocks two key inflammatory signals called Interleukin-4 (IL-4) and Interleukin-13 (IL-13) at the same time.
• Lebrikizumab: Specifically targets only the IL-13 signal.
• Nemolizumab: Directly targets the itch signal (IL-31) and is a powerful option for patients in whom itching is very dominant.

These treatments are generally in the form of injections that the patient administers to themselves every 2 or 4 weeks. Their side effects (most commonly dryness/conjunctivitis in the eyes or injection site reaction) are generally mild, and their long-term safety profiles are excellent.

What Are “Smart Pills” (JAK Inhibitors) in Atopic Dermatitis Treatment?

Developed as an alternative to biological agents, “Janus Kinase (JAK) Inhibitors” (e.g.: Upadacitinib, Abrocitinib) are small-molecule “smart pills.”

While biologics block signals outside the cell, JAK inhibitors enter the cell and shut down the “factory settings” of the inflammatory signal from the inside.

Which Treatment Is Better: An Injection (Biological) or a Pill (JAK) for Eczema?

Both treatment groups have revolutionized the treatment of moderate-to-severe eczema and are extremely effective. However, there are important differences between them, and the choice is individualized according to the patient’s needs:

• Response Speed:

JAK Inhibitors (Pills): Their effects begin very quickly. Because they provide broad-spectrum suppression, they can provide dramatic improvements in itching and skin findings within days.

Biologics (Injections): Their effects begin more slowly, and it may take weeks for the full effect to settle.

• Safety and Side Effect Profile:

Biologics (Injections): Because they are highly targeted, their long-term safety profiles are better. They require less laboratory monitoring. The most common side effects are dry eyes and injection site reactions.

JAK Inhibitors (Pills): Although they are effective, their side effect profiles are different because they provide broader immune suppression. Conditions such as acne (pimples), increased blood lipids, and increased risk of some infections may be seen. Therefore, patients using these medications need to be under strict laboratory follow-up with regular blood tests.

In clinical practice, JAK inhibitors come to the forefront for rapid response in patients who require urgent control and have very severe flare-ups; whereas biological agents stand out as a suitable primary option in patients who prioritize long-term safety, sustained remission, and a lower side effect profile.