The redness, discoloration, dryness, and itching caused by atopic dermatitis (AD) may send you to your dermatologist for solutions. Your doctor will begin by assessing your symptoms.
“The first thing is to assess the severity of the disease,” says Lindsay Strowd, MD, assistant clinical professor of dermatology and deputy chief of dermatology at Wake Forest Baptist Health.
Doctors find out how severe your Alzheimer’s disease is by how much of your body surface is affected. The more areas of inflamed skin, the more severe your condition. They also look at the area of your body where AD is located. In addition, severe Alzheimer’s disease also tends to have a deeper red color, Strode says. But for some with darker skin, the skin may appear discolored instead of red. It may end up lighter in color after the acute inflammation is gone. Your skin may be thicker than usual and open when you scratch it often.
Another sign that you need more intensive treatment is that the topical medications haven’t controlled the redness, discoloration, and itching. Alzheimer’s itch can be severe enough to interfere with your sleep and work. Your doctor will ask you how much itching you feel and how Alzheimer’s affects your daily life. “These components will guide our treatment choices,” says Strode.
Creams and light treatments
Topical treatment may be sufficient to treat a mild case of Alzheimer’s disease. Coal tar has been used for more than 100 years to treat Alzheimer’s disease and other skin conditions. Steroid creams help control itching and give your skin a chance to heal. Calcineurin inhibitors such as pimecrolimus (Elidel) and tacrolimus (Protopic) reduce the immune response to reduce inflammation in your skin.
A newer type of topical treatment is crisaborole (Eucrisa). This ointment helps relieve inflammation, itching, and rashes in people ages 2 and up.
A group of new drugs called Janus kinase (JAK) inhibitors has been approved for Alzheimer’s disease. They block the pathway that leads to the release of inflammatory chemicals in the body. Ruxolitinib (Opzelura) is available as a cream.
Light therapy, also called phototherapy, is an option if you have Alzheimer’s disease over large areas of your body. A dermatologist may also recommend this treatment for spots on places like the hands and feet that don’t improve with topical treatments. Phototherapy uses ultraviolet light to help clear your skin.
If you have severe Alzheimer’s disease or your skin does not improve from these treatments, it may be time to consider more body-wide or advanced therapies.
Systemic medications work throughout the body to treat larger areas of Alzheimer’s disease. Dermatologists use a few medications off-label, which means they’re approved to treat other conditions but also work on Alzheimer’s disease.
One body-wide treatment is cyclosporine, which suppresses an overactive immune system response. “This is a very powerful drug that reduces inflammation in the skin,” says John Hannivin, MD, professor emeritus of dermatology at Oregon Health & Science University College of Medicine.
Other drugs that work in a similar way include:
- Azathioprine (Azasan, Imuran)
- methotrexate (Rheomatrex, Trexall)
- mycophenolate mofetil (CellCept)
One downside to these treatments is that they can cause serious side effects, including:
- Kidney or liver damage
- high blood pressure
- shaking (tremor)
- Electrolyte imbalances
Newer approaches to treating moderate to severe Alzheimer’s
In 2017, the Food and Drug Administration approved the first biologic drug for Alzheimer’s disease, called dupilumab (Dupixent). It treats moderate to severe Alzheimer’s disease in adults and children 6 years of age and older.
Dupixent comes as an injection under the skin once every two weeks. It works by blocking two types of proteins that cause inflammation in Alzheimer’s disease: interleukin-4 (IL-4) and interleukin-13 (IL-13).
“If you think the skin is burning, take a medication such as methotrexate or prednisone [a steroid] Acts like a fire blanket. It puts out a fire, says Strode, whereas a drug like Dupixent is like using a fire extinguisher and shooting at the source of a fire. It’s a more specific goal.”
In studies, Dupixent cleared the skin, relieved itching, and improved quality of life in people with Alzheimer’s disease. More than half of those who took it for 16 weeks said they had 75% fewer symptoms. These improvements will continue in the long term.
Strowd calls Dupixent a “real game-changer.” “It has been very successful in bringing about rapid improvement, both in the skin disease and in the itching,” she says. (Strowd participated in clinical trials for Dupixent.)
Dupixent is also safe. The most common side effects are mild, including:
- Skin reactions where you got the shot
- Cold sores on the mouth or lips
- Eye and eyelid redness, swelling and itching
- pink eye
One downside to Dupixent is its cost, which runs over $3,200 per shot. How much you actually pay depends on what type of health insurance you have. Your insurance company may want you to try less expensive medications first before they cover the cost of Dupixent, Hanifin says.
Another biologic, tralokinumab-ldrm (Adbry), was approved by the US Food and Drug Administration in December 2021 for adults ages 17 and older. It is also an interleukin inhibitor that inhibits IL-13. You take it every two weeks. Side effects are similar to those of Dupixent. The cost is also similar, so you will need to check your insurance coverage to see if it covers you.
Some JAK inhibitors can be taken as tablets, which can be a plus if you don’t like needles. They include the drugs aprocitinib (Sibenko) and obadacitinib (Rinfuq).
Life changing treatments
Newer therapies such as Dupixent have improved the outlook for people with Alzheimer’s disease. They have made it possible for many people with this condition to have clear or nearly clear skin.
“It completely changes people’s lives when they were suffering,” says Strode. “It is a very useful part of treating this disease in our modern era.”