4 Pearls for Managing Atopic Dermatitis
From black tea compresses to effective mind-body interventions for symptom control, Peter Lio, MD, shares 4 pearls for effective AD management.
Pearl: Write an action plan. "One of the most important things we can do is develop an eczema action plan for our patients," Dr Lio said to a room of fellow clinicians at the conference. The action plan should outline flare management, maintenance strategies, and additional supportive measures.
Pearl: Steroid-free treatment ladder. "A lot of patients will start the visits with me saying, 'Whatever you do, I don't want any more topical steroids," Dr Lio said during his presentation. The development of biologics and Janus kinase (JAK) inhibitors has made a nonsteroidal treatment approach possible for patients with atopic dermatitis. To help guide clinicians on the use of these treatments, Dr Lio and colleagues created a therapeutic ladder dividing nonsteroidal medication classes into therapies for exacerbation vs maintenance in escalating order of increasing potential for adverse effects.
Reference: Ch'en PY, Lio PA. Nonsteroidal Approaches for Atopic Dermatitis: A Clinical Update. Dermatitis. 2024;35:596-604. doi: 10.1089/derm.2023.0373
Pearl: Mind-body interventions for symptom control. Interventions that prioritize the mind over the body can be beneficial for symptom control among patients with atopic dermatitis. One of the most powerful mind-over-body techniques, according to Dr Lio, is habit reversal therapy. This can include encouraging patients to replace scratching with gentle rubbing, acupressure, or worry beads. A pilot study showed that pressing on an acupressure point helped alleviate itch among people with atopic dermatitis.
Reference: Lee KC, Keyes A, Hensley JR, et al. Effectiveness of acupressure on pruritus and lichenification associated with atopic dermatitis: A pilot trial. Acupunct Med. 2012;30:8-11. doi: 10.1136/acupmed-2011-010088
Pearl: Black-tea compress for facial eczema. A study published in the Journal of Dermatological Treatment showed the effectiveness of black tea compresses for facial atopic dermatitis. Patients applied a cooled, diluted black tea compress to affected areas and saw significant improvement within the first 3 days of therapy, and further reduction of disease activity between day 3 and 6.
Reference: Witte M, Krause L, Zillikens D, Shimanovich I. Black tea dressings - a rapidly effective treatment for facial dermatitis. J Dermatolog Treat. 2019;30:785-789. doi:10.1080/09546634.2019.1573306
Dr Lio recommended the following black tea compress recipe that he uses with patients:
- Brew 1 bag of unflavored black tea for 10 minutes in 1 cup of
boiling water. - Add another cup of boiling water to brew a second cup using the same tea bag from step 1 and allow this weaker tea to cool to room temperature.
- Soak a soft cloth or gauze in the weak tea infusion and ring out gently.
- Apply damp compress to the affected areas for 15-20 minutes.
- Immediately apply moisturizer afterward to prevent dryness.
At the 2025 Winter Clinical Dermatology Conference, Peter Lio, MD, a clinical assistant professor of dermatology & pediatrics at Northwestern University, provided clinicians with practical pearls for managing atopic dermatitis, emphasizing personalized and integrative approaches to treatment.
