Atopic dermatitis treatment in Calgary

Atopic dermatitis diagnosisand treatment in Calgary.

Atopic dermatitis is the most common chronic inflammatory skin disease, affecting up to one in five children and one in ten adults. At Rejuvenation Dermatology Calgary South, Dr. Paul Kuzel, a board-certified dermatologist, treats patients of all ages with a stepped plan that runs from barrier care to the biologics and JAK inhibitors now available for moderate and severe disease.

Book a consultation Call (403) 286-6888

14Years of training FRCPCRoyal College certified VPAlberta Society of Dermatologists

What it is

Genetics, barrier failure and an overactive immune response.

Atopic dermatitis is the form of eczema that runs in families with asthma and hay fever. Three factors combine to produce it, and effective treatment addresses all three.

GeneticsMutations in the filaggrin gene, which builds the outer layer of the skin, are the strongest known risk factor. A child with one affected parent has roughly a one in three chance of developing atopic dermatitis; with two affected parents, higher still.

The barrierSkin with a defective barrier loses water, dries out, and admits irritants, allergens and microbes. Staphylococcus aureus colonises most atopic skin and drives inflammation even when there is no visible infection.

The immune responseThe immune system responds to what crosses the barrier with a type 2 inflammatory pattern, driven by interleukin 4, interleukin 13 and interleukin 31. These signals cause the redness, swelling and, above all, the itch. The newest treatments block them directly.

By age

The pattern changes with age.

Atopic dermatitis presents differently in an infant, a school-age child and an adult, and the treatment plan is adjusted for each. Many children improve substantially by adolescence; a proportion carry the condition into adult life, and some develop it for the first time as adults.

Under two

Infants

Onset is usually between two and six months. The rash affects the cheeks, scalp and the outer surfaces of the arms and legs, and is often weepy. The nappy area is typically spared.

Sleep disruption for the child and the household is the main burden
Treated with emollients and low-potency topical steroids, safely and effectively
Food allergy is investigated selectively, not routinely

Two to twelve

Children

The rash moves to the creases: the inner elbows, behind the knees, the wrists, ankles and neck. Skin thickens where it is scratched. Flares track with infections, dry winters and stress.

Around half of children with atopic dermatitis develop asthma or hay fever
Written action plans reduce flares and reduce steroid use overall
Dupilumab is approved from six months of age for moderate to severe disease

Adolescents and adults

Adolescent and adult disease

Persistent or recurrent eczema of the creases, hands, eyelids and face, with thickened, dry, intensely itchy skin. Hand involvement is common and often worsened by work.

Impact on sleep, concentration and mood is well documented
The full range of systemic treatment is available

The atopic march

Asthma, hay fever and food allergy

Atopic dermatitis is often the first of a sequence of allergic conditions. Early, effective barrier repair may reduce the risk of the others, and the association is one reason to treat infant eczema promptly rather than waiting for it to resolve.

Why a dermatologist

Correct diagnosis, correct steroid use, and access to systemic treatment.

Most atopic dermatitis that is poorly controlled is poorly controlled because the treatment is wrong for the severity, is being used incorrectly, or has never been stepped up. A dermatologist corrects each of these.

DiagnosisContact dermatitis, seborrheic dermatitis, psoriasis, scabies and fungal infection are all mistaken for atopic dermatitis. In adults with new-onset eczema, patch testing and occasionally biopsy exclude other causes.

Correct topical therapyTopical steroids are safe when the potency matches the site and the course is defined. Under-treatment from steroid fear is the most common reason for failure. Dr. Kuzel prescribes by site and by weight, with written instructions and a maintenance plan.

Stepping up when neededNarrowband UVB phototherapy, dupilumab, tralokinumab, lebrikizumab and the oral JAK inhibitors are prescribed and monitored here. Special authorisation and the screening each requires are managed in clinic.

Covered as medical careAssessment and treatment of atopic dermatitis is medical dermatology, generally covered by Alberta Health Care with a referral from your family physician or paediatrician. Phototherapy is a covered service. Biologics and JAK inhibitors are covered by Alberta's drug plans and most private insurers with special authorisation.

Grading severity

Severity decides the treatment step.

Severity is graded by the extent of the rash, its intensity, and its effect on sleep and daily life. The grade is recorded at each visit so that response to treatment can be measured rather than estimated.

What is assessed

Body surface area involved
Redness, thickening, scratching damage and weeping
Itch intensity on a ten-point scale
Nights of disturbed sleep per week
Days of work or school affected
Number of flares and courses of treatment in the past year
Signs of skin infection

Referrals and coverage

Assessment and treatment of atopic dermatitis is medical care, generally covered by Alberta Health Care with a referral from your family physician or paediatrician. Ask them to refer you or your child to Dr. Paul Kuzel at Rejuvenation Dermatology Calgary South, or have the referral faxed to (403) 225-2914.

If you do not have a family doctor, call (403) 286-6888 and the team will advise on the fastest route to be seen. Infants and children are welcome.

Treatment

A stepped approach, from barrier care to systemic therapy.

Every patient starts on the first step and stays there. Each further step is added when the one before is not enough, and removed again once the skin is stable.

Step one, every patient

Basic therapy

A thick, fragrance-free emollient applied to the whole body at least twice daily and within three minutes of bathing. Short, lukewarm baths with a soap-free cleanser. Cotton clothing, short nails, a bedroom humidifier through the Calgary winter. Dilute bleach baths twice weekly where staph colonisation drives flares.

Reduces flares by up to half on its own
Continues through every further step

Step two

Topical anti-inflammatories

Topical corticosteroids, with potency matched to the site: mild for the face and folds, moderate to potent for the trunk and limbs, used daily during a flare and twice weekly on trouble spots between flares. Non-steroid alternatives, including tacrolimus, pimecrolimus, crisaborole and ruxolitinib cream, for delicate sites and long-term use.

Written plan: which cream, where, how much and for how long
Wet wrap therapy for severe flares, in clinic or taught for home use

Step three

Phototherapy

Narrowband UVB, two or three sessions a week for eight to twelve weeks, for widespread disease that topical treatment does not control. Reduces inflammation and itch without systemic medication. Suitable for adults and older children.

UV therapy

Step four

Biologics and JAK inhibitors

Dupilumab, tralokinumab and lebrikizumab are injectable antibodies that block the interleukin signals driving atopic dermatitis, with clear or nearly clear skin in most patients and marked reduction in itch within weeks. Upadacitinib and abrocitinib are oral JAK inhibitors with a faster onset. Methotrexate and cyclosporine remain options in selected cases.

For moderate to severe disease not controlled by steps one to three
Dupilumab is approved from six months of age
Screening, authorisation and monitoring handled in clinic

Any step

Infection control

Sudden worsening with weeping, yellow crusting or pain usually indicates bacterial infection and is treated with antibiotics before the eczema treatment can work. Widespread small blisters may indicate eczema herpeticum, which requires urgent antiviral treatment.

When indicated

Allergy assessment

Patch testing for contact allergy where the pattern suggests it, particularly in adults and in eczema of the hands, face or eyelids. Food allergy testing in infants with severe eczema and a history of reactions, in coordination with allergy specialists. Routine allergy testing is not recommended.

Patch testing

Your visit

Assessment, a written action plan, and follow-up.

Atopic dermatitis is managed over years and across seasons. The first visit establishes the diagnosis and severity, and every patient leaves with a written plan.

HistoryAge of onset, pattern, triggers, sleep, previous treatments and how they were used, and any asthma, hay fever or food allergy in the patient or family.

ExaminationThe whole skin, with severity graded and recorded. Swabs, scrapings or biopsy where infection or another diagnosis is possible.

Action planWritten, and specific to the patient: daily care, flare treatment by body site, and the point at which to return.

Follow-upFour to eight weeks later. Severity is re-graded and treatment is stepped up or down accordingly.

Long-term careReview before each winter, and at intervals set by the treatment step. Systemic therapy is monitored to schedule.

What to expect

Expected outcomes.

Atopic dermatitis cannot be cured, but it can be controlled at every severity. With correct basic and topical therapy, most mild and moderate disease is clear or nearly clear within four to eight weeks and remains controlled with maintenance. Flares still occur, particularly through the Calgary winter, and the action plan is designed to end them early.

For moderate to severe disease, biologic therapy produces clear or nearly clear skin in the majority of patients within sixteen weeks, and itch improves within the first two to four weeks. JAK inhibitors act faster still. Sleep, concentration and mood improve in parallel with the skin.

Many children improve substantially by adolescence. The tendency to dry, sensitive skin usually persists, and basic care continues for life.

4 to 8Weeks to control with topical therapy 16Weeks to full biologic response 1Written action plan

Questions

Questions about atopic dermatitis, answered.

What is the difference between atopic dermatitis and eczema?

Eczema is the general term for a group of inflammatory skin conditions. Atopic dermatitis is the most common member of that group, the one that runs in families with asthma and hay fever and usually begins in childhood. Contact dermatitis, hand eczema and seborrheic dermatitis are other forms of eczema with different causes.

Will my child grow out of it?

Many children improve substantially by adolescence, and a majority have mild or no disease as adults. A significant minority continue to have atopic dermatitis into adult life, and the tendency to dry, sensitive skin persists in most. Early, effective treatment improves the course and may reduce the risk of asthma and allergies.

Is treatment covered by Alberta Health Care?

Assessment and treatment of atopic dermatitis is medical dermatology and is generally covered with a referral from your family physician or paediatrician. Phototherapy is a covered service. Prescriptions are covered by most drug plans. Biologics and JAK inhibitors are covered by Alberta's plans and most private insurers with special authorisation, which Dr. Kuzel's office handles.

Do I need a referral?

For care billed to Alberta Health Care, a referral from a physician is the normal route, and it can be faxed to (403) 225-2914. If you do not have a family doctor or would rather not wait, call (403) 286-6888 and the team will tell you the quickest way to be seen.

Are topical steroids safe for children?

Yes, when the potency is matched to the site and the child's age, and the course is defined. Decades of use support their safety in children. Skin thinning results from prolonged use of potent steroids on thin skin, not from a properly prescribed course. Under-treatment leaves a child itching, scratching and losing sleep, which causes more harm than correct treatment.

Is dupilumab safe for children?

Dupilumab is approved in Canada for atopic dermatitis from six months of age and has been studied in thousands of children. It does not suppress the immune system in the way older systemic drugs do and requires no routine blood monitoring. The most common side effects are injection site reactions and conjunctivitis. Dr. Kuzel reviews the risks and benefits with parents before prescribing.

Should we test for food allergies?

Not routinely. Food allergy is a trigger in a minority of infants with severe eczema, and testing is reserved for children with a history of reactions or eczema that does not respond to treatment. Removing foods without evidence rarely improves the skin and can harm growth. Where testing is appropriate it is coordinated with an allergy specialist.

What are bleach baths?

A bath with a small measured amount of household bleach added, roughly the concentration of a swimming pool, taken twice a week for five to ten minutes. It reduces the staph bacteria that colonise atopic skin and drive inflammation, and reduces flares and infections. It is safe for children when prepared as directed.

Why is it worse in winter?

Dry air. Calgary's winter air holds very little moisture, indoor heating removes more, and the skin barrier loses water faster than it can be replaced. Thicker emollients, a bedroom humidifier and shorter baths from October onward prevent most winter flares, and the plan is reviewed before the season rather than after the flare.

Who provides the care?

Dr. Paul Kuzel, MD FRCPC, a board-certified dermatologist and the founder and Medical Director of Rejuvenation Dermatology Calgary South. He sees patients in English and Czech.

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Book a consultation.

Book a consultation with Dr. Kuzel, or ask your family physician or paediatrician for a referral. Infants and children are welcome.