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Dermatitis Therapy – Treatment of Skin Inflammation

Dermatitis therapy covers all treatment approaches used to relieve skin inflammation. Depending on the cause, topical, systemic, or behavioural strategies may be applied.

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Things worth knowing about "Dermatitis Therapy"

Dermatitis therapy covers all treatment approaches used to relieve skin inflammation. Depending on the cause, topical, systemic, or behavioural strategies may be applied.

What Is Dermatitis?

Dermatitis is an umbrella term for various forms of skin inflammation. It can follow an acute or chronic course and typically presents with redness, itching, swelling, and scaling of the skin. The most common types include atopic dermatitis (eczema), contact dermatitis, seborrhoeic dermatitis, and stasis dermatitis. Treatment is always guided by the underlying cause and the severity of the condition.

Goals of Dermatitis Therapy

The treatment of dermatitis aims to relieve itching and inflammation, restore the skin barrier, avoid triggers, and prevent relapses. An individually tailored therapy plan is essential for long-term treatment success.

Topical Therapy

Topical (external) treatment is usually the first-line approach in dermatitis management:

Corticosteroids (cortisone creams): Anti-inflammatory agents used during acute flares. They effectively reduce redness, swelling, and itching but should not be used long-term without medical supervision.
Calcineurin inhibitors: Agents such as tacrolimus and pimecrolimus are used as corticosteroid-sparing alternatives, particularly in sensitive skin areas (e.g., face, eyelids).
Moisturisers (emollients): Rehydrating creams and lotions strengthen the skin barrier and reduce dryness. They form an indispensable part of baseline therapy in chronic dermatitis.
Antipruritic agents: Itch-relieving preparations (e.g., containing polidocanol or urea) can be used as supportive treatment.

Systemic Therapy

For severe or widespread forms of dermatitis, systemic (internal) treatment may be required:

Antihistamines: Block the action of histamine and relieve allergy-related itching.
Systemic corticosteroids: Used short-term during severe flares; long-term use should be avoided due to side effects.
Immunosuppressants: Agents such as ciclosporin or methotrexate are used in severe atopic dermatitis when other treatments prove insufficient.
Biologics: Modern targeted therapies such as dupilumab (a monoclonal antibody) block specific inflammatory pathways (IL-4/IL-13) and are highly effective in severe atopic dermatitis.
JAK inhibitors: Newer agents (e.g., baricitinib, upadacitinib) inhibit intracellular inflammatory signalling pathways and provide an additional option for moderate-to-severe atopic dermatitis.

Light Therapy (Phototherapy)

Phototherapy uses ultraviolet light (UV-B or PUVA) to reduce skin inflammation. It is used for chronic atopic dermatitis or treatment-resistant forms of the disease. Treatment is typically carried out on an outpatient basis in dermatology practices or clinics.

Therapy by Dermatitis Type

Atopic Dermatitis (Eczema)

The main focus is on baseline therapy with emollients, avoidance of trigger factors (e.g., house dust mites, pet dander, stress), and the use of topical corticosteroids or calcineurin inhibitors during flares. In severe cases, biologics or JAK inhibitors are indicated.

Contact Dermatitis

The most important step is the identification and avoidance of the causative contact substance. Topical corticosteroids and moisturising products are used as supplementary treatment. In allergic contact dermatitis, a patch test can help identify the trigger.

Seborrhoeic Dermatitis

Antifungal agents (e.g., ketoconazole) in shampoos or creams are the treatment of choice, as yeast fungi (Malassezia) play a key role. Mild topical corticosteroids may be used in addition.

Stasis Dermatitis

Treatment focuses on improving venous circulation: compression therapy, leg elevation, and moisturising topical products are the primary interventions.

Non-Pharmacological Measures

In addition to medication, behavioural and supportive measures play an important role:

Regular skin care using fragrance-free, moisturising products
Short, lukewarm baths or showers to protect the skin
Wearing soft, skin-friendly clothing (e.g., cotton)
Stress management and psychological support for chronic cases
Patient and family education programmes (especially for atopic dermatitis)

References

Wollenberg A. et al. - European guideline (EuroGuiDerm) on atopic eczema. Journal of the European Academy of Dermatology and Venereology, 2022.
Fonacier L. et al. - Contact Dermatitis: A Practice Parameter Update. Annals of Allergy, Asthma and Immunology, 2015.
Braun-Falco's Dermatology. Springer Medizin Verlag, 7th edition (2018).

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