Managing atopic dermatitis (AD, also known as eczema) can be fraught with uncertainty about when the next flare-up will happen. You may go weeks or even months without any symptoms, only to have acute, intense inflammation and itching come up suddenly — necessitating treatments like topical steroids or calcineurin inhibitors.

Not only can this be frustrating in the moment, but over time, the "flare-fix" cycle can take a toll on physical and emotional well-being, says Mona Foad, MD, a dermatologist and the founder of MONA Dermatology in Cincinnati.

"When the skin is constantly inflamed, or going through cycles of inflammation, the body never fully gets a chance to reset," she explains. "Over time, this can increase levels of stress hormones and inflammatory cytokines, leading to persistent discomfort, sleep disruption, lower self-confidence, and mood changes."

That's why switching from a reactive perspective — treating flares as they happen — to a proactive approach is important, says Dr. Foad. By addressing underlying inflammation, it may be possible to stop the flare-fix cycle and manage AD more effectively. Here's a look at why "good enough" falls short, along with strategies that may help with prevention.

When you have an AD flare, it’s crucial to address it promptly to shut down intense itching and dry skin, as well as limit the spread of scales and inflamed patches, says Foad. But topical treatments like moisturizers, over-the-counter hydrocortisone, and prescribed topical medicines only offer short-term relief; they don't address what might be prompting the flares in the first place.

This is like putting out fires without recognizing what's starting them, Foad adds. Particularly with moderate to severe AD, those cycles can be stressful, which then leads to higher risk of more flares.

"Stress activates the body’s stress-response system, including the release of cortisol and other neurochemicals that can disrupt the skin barrier and immune balance," she says. "In patients with atopic dermatitis, this stress response can worsen inflammation, impair barrier repair, and increase itch sensitivity."

That can affect everything from self-esteem and sleep quality to emotional regulation and work effectiveness. For example, research on AD and work impairment found that productivity loss and lower quality of life increased with AD severity.

Not everyone with AD who experiences flares will need to consider systemic medications, since more mild forms of the condition may have only occasional and minor symptoms that aren't disruptive, says Amy Huang, MD, a dermatologist at Medical Offices of Manhattan in New York City.

"If you're supporting your skin barrier with emollients and seem to be managing your atopic dermatitis that way, then that may be all that's necessary to treat the condition," she says. But if daily skin-care routines and lifestyle habits are on point, but you're still having flares, that's when it may be time to consider the next step. Some signs of that include:

• More frequent and intense flares

• Thickening skin due to long-term rubbing or scratching

• Excessively dry skin that isn't relieved with topical remedies

• Cracked or broken skin that becomes prone to infection

• Sleep disruption due to itching

• Anxiety, depression, or feeling isolated

Tracking how often flares happen and whether there were any triggers involved, like food allergies, change in laundry detergent, or dry air, can help determine whether the condition is getting worse, says Dr. Huang.

Systemic treatments for AD target the immune system, rather than addressing only the skin barrier. The options include immunosuppressants, biologics, and JAK inhibitors. Here's what’s involved with each of these.

Immunosuppressants

These are used for moderate to severe AD when topicals aren't working, and they reduce overactive immune responses. Common options are pills that you may take as often as twice a day. They can be used to help stop the itch-scratch cycle of AD, allowing the skin to heal, which lowers risk of skin infection.

Biologics

Also known as biologic drugs, these are given by injection and work to block a type of chemical messenger in the body called an interleukin, which is associated with an overactive immune response. Biologics prevent interleukin from binding to cell surface receptors, reducing immune reactions and, subsequently, inflammation related to AD.

JAK Inhibitors

Janus kinase (JAK) inhibitors are nonsteroid oral medications designed for long-term treatment of moderate to severe AD. Inflammation with the condition is prompted in part by cytokines, which are sent out by the immune system in response to threats. JAK inhibitors target cytokine pathways to block those signals, lowering inflammation as a result.

Switching to a systemic option that’s proactive instead of reactive can allow you to jump out of the flare-fix cycle. But it’s likely that your AD management will still involve some type of topical treatment, along with lifestyle factors like recognizing and reducing triggers, says Tanya Evans, MD, a dermatologist at MemorialCare Saddleback Medical Center in Laguna Hills, California.

"Managing atopic dermatitis often requires a number of strategies in addition to a specific medication, even with a systemic approach," she explains. "For example, your doctor may suggest trying light therapy, adding a topical vitamin D ointment, or being tested for food allergies. It's also important to acknowledge if there are any emotional health challenges, so you can explore treatment for that as well."

That's why it's important to work with your doctor and health team to address all aspects of atopic dermatitis treatment, she adds. While systemic medications may not eliminate flares completely, for those with moderate to severe AD, they could be part of a more comprehensive condition-management strategy.

• Moderate to severe atopic dermatitis can come with frequent flares that take a toll on both physical and mental health.

• Moving from a reactive to a proactive approach using systemic therapies may give you better AD symptom control.

• Even with systemic medications, it's still important to address lifestyle and environmental factors that affect AD.