Sensitive skin due to eczema is predicated only on physical barrier disruption, while the sensitive skin associated with atopic dermatitis is predicated both on a barrier defect and an immune hyper-reactivity, as manifested by the association of asthma and hay fever. Patients with atopic dermatitis not only have sensitive skin on the exterior of the body, but also sensitive mucosa lining the eyes, nose, and lungs. Thus, the treatment of sensitive skin in the atopic population involves topical and systemic considerations. There is also a prominent link between the worsening of hay fever and the onset of skin symptoms, requiring broader treatment considerations.
All of the treatments previously described for eczema also apply to atopic dermatitis, but additional therapy is required to minimize the immune hyper-reactivity. While this may take the form of oral or injectable corticosteroids, antihistamines (hydroxyzine, cetirizine hydrochloride, diphenhydramine, fexofenadine hydrochloride, etc.) are typically added to decrease cutaneous and ocular itching. Antihistamines also improve the symptoms of hay fever and may prevent a flare up should the patient be exposed to pollens or other inhaled allergens. The avoidance of sensitive skin in the atopic patient is largely predicated on avoidance of inciting substances. This means creating an
allergy-free environment by removing old carpet, nonwashable drapes, items likely to collect dust, feather pillows and bedding, stuffed animal toys, heavy pollinating trees and plants, pets, etc. The prevention of the release of histamine is the key to controlling the sensitive skin of atopic dermatitis.