Lifestyle Medicine and Atopic Dermatitis in Viet Nam: Skin Barrier Care, the Itch–Sleep Cycle, and Treatment Safety

Lifestyle Medicine and Atopic Dermatitis in Viet Nam: Skin Barrier Care, the Itch–Sleep Cycle, and Treatment Safety

Last reviewed: October 31, 2026

A parent may apply moisturizer to a child's skin every day for several weeks, notice that the dryness has improved, and gradually stop using it. When itching returns, the family starts searching for another cream, a different soap, or a food that might be responsible.

An adult with atopic dermatitis may face a different problem. Itching becomes more troublesome at night, scratching repeatedly interrupts sleep, and the following morning begins with fatigue and difficulty concentrating. Several treatments may already have been tried, but concerns about medication safety make it difficult to follow the prescribed plan consistently.

Atopic dermatitis affects much more than the appearance of the skin. It is a chronic inflammatory disease involving abnormalities in skin barrier function, immune regulation, and interactions with environmental factors. Its consequences can extend to sleep, emotional well-being, daily activities, and family life.

Lifestyle Medicine can contribute through appropriate skin-care behaviors, attention to relevant environmental exposures, support for sleep and psychological well-being, and strategies that help patients maintain effective treatment. However, these measures must complement, rather than replace, medically indicated anti-inflammatory therapy or specialist care.

For healthcare professionals in Viet Nam, the challenge is to distinguish evidence-based self-care from unproven remedies, understand the barriers patients face in maintaining treatment, and assess whether care is producing meaningful improvements in symptoms and quality of life.

Understanding Atopic Dermatitis as an Inflammatory Skin Disease

Atopic dermatitis develops through a complex interaction between skin barrier abnormalities, immune responses, genetic susceptibility, environmental exposures, and other factors.

The outermost layer of the skin normally helps retain moisture and protect against irritants, microorganisms, and other external exposures. In atopic dermatitis, this protective function may be impaired, allowing greater water loss and increased penetration of substances that contribute to irritation and inflammation.

Changes involving skin barrier proteins, epidermal lipids, immune signaling, and the skin microbiome may also contribute to the disease.

However, atopic dermatitis cannot be explained entirely by dry skin. Inflammation and itching may persist even when the skin appears adequately moisturized. Conversely, skin dryness can occur for many reasons unrelated to atopic dermatitis.

This distinction helps explain why moisturizer alone may not adequately control active inflammatory lesions.

Atopic dermatitis commonly follows a relapsing course, with periods of improvement interrupted by flares. Its appearance and distribution vary according to age, disease duration, skin pigmentation, and anatomical location.

Infants and young children may have different patterns of skin involvement from adolescents and adults. On more deeply pigmented skin, inflammation may be less visibly red, while pigmentary changes, follicular lesions, or skin thickening may be more prominent.

Diagnosis is primarily clinical, based on the patient's history and examination findings. Persistent or recurrent itching, characteristic eczematous lesions, skin dryness, affected body areas, and a personal or family history of atopic conditions may support the diagnosis.

However, no single symptom or laboratory test confirms every case.

Contact dermatitis, fungal infection, scabies, psoriasis, and other dermatological conditions may resemble or coexist with atopic dermatitis. When the diagnosis is uncertain or treatment response is unexpectedly poor, clinicians should reconsider whether another condition is contributing to the symptoms.

This issue was addressed in an American Academy of Dermatology guideline published online on August 31, 2026, concerning diagnostic evaluation in adults with presumed atopic dermatitis that remains unresponsive to optimized treatment.

The guideline supports diagnostic reassessment and consideration of investigations such as patch testing, skin scraping, or biopsy when clinically appropriate. Its recommendations draw substantially on indirect evidence and expert consensus because direct studies comparing diagnostic strategies remain limited.

The guidance should therefore not be interpreted as requiring routine testing for every patient.

Accurate diagnosis is particularly important before introducing more intensive treatment. A patient whose symptoms persist despite appropriate therapy may have inadequately controlled atopic dermatitis, but the possibility of an alternative or additional diagnosis should not be overlooked.

What the Latest International Guidelines Recommend

The evidence base for atopic dermatitis management has expanded considerably in recent years.

The American Academy of Dermatology published updated adult topical treatment recommendations in 2023, followed by guidance on systemic therapies and a focused update in 2025 addressing several newer medications.

On April 7, 2026, the Academy published dedicated evidence-based guidelines for managing atopic dermatitis in children and adolescents, together with separate guidance concerning primary prevention and awareness of associated conditions.

The pediatric treatment guideline contains 27 evidence-based recommendations developed through systematic review and structured assessment of evidence certainty.

These recommendations strongly support established interventions such as moisturizers, topical corticosteroids, and topical calcineurin inhibitors. They also address newer topical medications, biological therapies, and selected systemic treatments for appropriately eligible patients.

An important distinction concerns prevention.

The separate pediatric prevention guideline makes a conditional recommendation in favor of moisturizing skin care to reduce the occurrence of atopic dermatitis in young children. The Academy's accompanying explanation identifies children aged six months to three years as the relevant age range.

However, this recommendation is conditional because the expected benefits, supporting evidence, and treatment burden differ from those associated with moisturizers used to manage established disease.

Preventing atopic dermatitis in a child who has not developed it and treating someone who already has the condition are different clinical objectives. Evidence supporting one should not automatically be interpreted as evidence supporting the other.

In Europe, the EuroGuiDerm living guideline was updated in April 2026, particularly concerning systemic treatment options and treatment algorithms.

Singapore's Agency for Care Effectiveness also published its guideline, Mild and Moderate Atopic Dermatitis (Eczema): A Journey From Flare to Care, on February 27, 2026, with the online version updated on July 29, 2026.

The Singapore guideline emphasizes accurate diagnosis, assessment of disease severity, regular moisturizing, appropriate topical anti-inflammatory treatment, proactive management of recurrent flares, and reassessment when treatment response is inadequate.

These international guidelines are valuable for professional education in Viet Nam, but they are not interchangeable.

Some primarily address adults, others focus on children, and some concentrate on particular levels of disease severity or treatment categories. They also reflect differences in healthcare systems, medicine approvals, resources, and clinical priorities.

Across these documents, a consistent approach emerges: maintaining skin barrier function, controlling inflammation appropriately, and helping patients understand their long-term treatment plan are complementary components of effective care.

Moisturizers Are Foundational, but Continued Use Matters

Regular moisturizing is one of the most established components of atopic dermatitis management.

Moisturizers can reduce dryness, support skin barrier function, relieve some symptoms, and contribute to longer-term disease control when used appropriately.

The American Academy of Dermatology strongly recommends moisturizers for both adults and children with established atopic dermatitis.

However, available evidence does not identify one moisturizer, vehicle, ingredient, or commercial formulation as the best option for every patient.

Product selection depends on skin characteristics, individual tolerance, preferences, cost, accessibility, and the likelihood of regular use.

Some people prefer ointments or thicker creams, while others find lighter formulations more comfortable, particularly in hot or humid conditions.

A product that causes stinging or irritation may not be suitable for a particular individual, even if it is marketed for sensitive skin.

Fragrance-free products may be useful for patients whose skin reacts to fragrances or related ingredients, but product selection should still reflect individual tolerance.

One common misunderstanding is that moisturizing can stop as soon as visible dryness improves.

Atopic dermatitis often involves an ongoing tendency toward skin barrier dysfunction, even during periods of good symptom control. Maintaining an appropriate moisturizing routine may therefore remain useful after the skin appears better.

Nevertheless, moisturizing and anti-inflammatory treatment serve different purposes.

A moisturizer supports skin barrier function, while prescribed anti-inflammatory medication treats inflammation. Both may improve symptoms, but they are not therapeutically equivalent.

Patients and caregivers benefit from understanding why moisturizing may continue during periods of improvement while anti-inflammatory medications are used according to an individualized treatment plan.

This distinction may also help reduce unnecessary switching between products when symptoms recur.

For someone who has already tried several moisturizers, the most useful next step may not be another product recommendation. It may be a review of whether the current routine is appropriate, whether active inflammation is adequately treated, and whether the selected products are comfortable and affordable enough for regular use.

Bathing, Heat, and Environmental Exposures

Bathing habits and environmental conditions can influence comfort and symptoms in people with atopic dermatitis.

Hot water, irritating cleansers, harsh detergents, and repeated exposure to certain substances may aggravate the skin in susceptible individuals.

Gentle cleansing and moisturizing after bathing can form part of an appropriate skin-care routine.

However, current evidence does not establish one bathing frequency or duration that is suitable for every patient.

The American Academy of Dermatology recognizes this uncertainty. Patients should not be told that following a rigid bathing schedule is necessary to prevent flares.

Advice about water temperature, cleansing products, and skin-care practices should instead reflect individual tolerance and circumstances.

Environmental exposures deserve similar attention.

Heat, sweating, friction, and contact with irritating substances may contribute to discomfort or worsening symptoms in some patients.

These considerations are relevant in Viet Nam, where people experience different combinations of hot weather, humidity, air conditioning, outdoor activity, and occupational exposures.

However, it would be inaccurate to suggest that Viet Nam's climate itself causes atopic dermatitis or that every patient benefits from the same environmental modifications.

Someone whose symptoms worsen after using a particular detergent may benefit from avoiding that product. Another person may experience discomfort associated with sweat and friction during physical activity.

These experiences should be assessed individually rather than interpreted as proof that all similar exposures are harmful.

The 2026 Singapore guideline recommends reviewing possible triggers and reducing relevant exposures when feasible, while recognizing that complete avoidance may not always be practical.

This is particularly important for patients whose occupations involve frequent handwashing, cleaning agents, wet work, protective gloves, or other irritants.

Their care may require occupational health measures, appropriate protective equipment, or changes to work practices in addition to individual skin-care advice.

Healthcare professionals should avoid placing responsibility entirely on patients when workplace or environmental conditions limit their ability to reduce exposure.

The purpose is to identify factors that genuinely influence symptoms and support realistic changes without suggesting that environmental control alone can prevent every flare.

The Itch–Scratch–Sleep Cycle Can Become a Major Burden

Itching is one of the defining symptoms of atopic dermatitis.

For some people, it is intermittent and relatively manageable. For others, it becomes persistent, interferes with concentration, and intensifies during the evening or night.

Scratching may provide temporary relief but can further damage the skin barrier, increase irritation, and contribute to ongoing inflammation. This interaction is commonly described as the itch–scratch cycle.

Sleep disturbance adds another dimension.

Patients may struggle to fall asleep because of itching, wake repeatedly to scratch, or feel unrefreshed the following morning.

Children may require attention or reassurance during the night, disrupting the sleep and well-being of parents and caregivers as well.

An observational study published in the October 2026 issue of the Journal of Investigative Dermatology reported impaired sleep quality among adults with atopic dermatitis, particularly those with multiple atopic conditions.

These findings reinforce the importance of assessing sleep. However, an observational association cannot establish that sleep disturbance is caused solely by skin inflammation.

Anxiety, other medical conditions, medication effects, and separate sleep disorders may also contribute.

The relationship between itching and sleep may operate in both directions. Severe itching disrupts sleep, while inadequate sleep and psychological distress may influence the experience of itching and the ability to cope with symptoms.

The precise mechanisms and effectiveness of individual sleep-focused interventions remain areas of ongoing research.

For healthcare professionals, sleep should be considered an important patient outcome rather than a secondary complaint.

Someone whose skin lesions appear relatively limited may still experience substantial nighttime itching and sleep disruption. Conversely, visible improvement in skin inflammation does not necessarily mean that sleep quality has recovered.

Both the clinical appearance of the skin and the patient's experience deserve attention.

Sleep Support Should Complement Control of Inflammation

Basic sleep-supporting behaviors may help patients whose rest is disrupted by atopic dermatitis.

Maintaining a reasonably consistent sleep schedule, making the sleeping environment comfortable, and reducing avoidable nighttime irritation may improve comfort.

However, these measures are supportive rather than disease-directed treatment.

When itching is driven by poorly controlled inflammation, sleep hygiene alone is unlikely to provide adequate relief.

Some patients use antihistamines in the hope of controlling itching or sleeping more comfortably. This approach requires careful consideration.

The American Academy of Dermatology recommends against routine use of topical antihistamines for atopic dermatitis. Evidence supporting oral antihistamines specifically for controlling eczema-related itching is also limited.

Sedating antihistamines can cause next-day drowsiness, impaired attention, and other adverse effects, depending on the medication, age, and clinical circumstances.

They should not be regarded as alternatives to controlling the underlying skin inflammation.

Some patients may have other appropriate indications for antihistamines, including coexisting allergic conditions, but treatment decisions should be made by qualified healthcare professionals.

Psychological and behavioral interventions may also help selected patients manage scratching, stress, or distress associated with chronic symptoms.

However, these approaches should not imply that atopic dermatitis is primarily a psychological condition.

The disease has established inflammatory and skin barrier-related mechanisms. Psychological care can support coping and well-being, but it cannot replace medically indicated dermatological treatment.

An integrated approach addresses skin symptoms together with their consequences for sleep, emotional health, and daily functioning.

Topical Corticosteroids: Balancing Safety With Effective Treatment

Topical corticosteroids remain among the most important anti-inflammatory treatments for atopic dermatitis.

They are widely used to control active eczematous inflammation and are strongly recommended by international guidelines when appropriately selected.

However, concerns about corticosteroid safety can become a significant barrier to treatment.

Some patients worry about skin thinning, systemic adverse effects, or long-term dependence. Parents may be especially reluctant to apply corticosteroids to a child's skin.

These concerns deserve careful discussion rather than dismissal.

Inappropriate use, particularly prolonged or excessive application of potent corticosteroids to sensitive areas, can cause adverse effects.

Potential complications include skin atrophy, striae, pigmentary changes, and other local effects. Risk depends on potency, formulation, treatment area, duration, extent of use, age, and other clinical factors.

However, these risks should not be exaggerated into a claim that all topical corticosteroids are inherently unsafe.

Appropriately prescribed topical corticosteroids are effective and generally well tolerated when used according to clinical guidance.

Undertreatment can also have consequences.

A patient who repeatedly stops prescribed anti-inflammatory treatment after only a few applications may continue to experience active inflammation, severe itching, sleep disruption, and recurrent flares.

Healthcare professionals should explain which medication is intended for which skin area, how it should be used, the expected treatment period, and when reassessment is needed.

The face, eyelids, skin folds, and other sensitive areas may require different treatment choices from thicker skin elsewhere on the body.

Children also require age-appropriate medication selection and monitoring.

Patients should not independently increase medication potency, apply potent corticosteroids over extensive areas, or continue treatment indefinitely without review.

The discussion should also distinguish adverse effects associated with inappropriate use from concerns about symptoms that may occur after stopping treatment. Persistent or worsening disease following withdrawal of medication can have more than one explanation, including recurrence of inadequately controlled inflammation.

Clinical assessment is necessary rather than automatically attributing every deterioration to medication dependence or withdrawal.

The appropriate educational message is balanced: avoid inappropriate corticosteroid use, but do not discourage effective treatment through unsupported fears.

Proactive Treatment Can Reduce Recurrent Flares

Many people with atopic dermatitis use anti-inflammatory medication only when their skin becomes visibly inflamed.

Once itching and redness improve, they stop treatment and wait for another flare.

For some patients with frequently recurring lesions, this pattern leads to repeated periods of uncontrolled inflammation.

International guidelines support proactive treatment strategies for appropriately selected patients.

Proactive treatment involves intermittent application of a prescribed topical anti-inflammatory medication to areas prone to recurrent eczema, together with continued skin barrier care.

Its purpose is to reduce future flares rather than repeatedly waiting for inflammation to become severe.

The 2026 Singapore guideline recommends proactive treatment for patients experiencing recurrent flares, including those with approximately two or three episodes per month.

American Academy of Dermatology recommendations also support selected maintenance approaches using topical corticosteroids or topical calcineurin inhibitors.

Evidence indicates that proactive anti-inflammatory treatment can reduce flare frequency in appropriate patients compared with treatment initiated only after symptoms recur.

However, proactive treatment does not mean applying potent corticosteroids continuously or independently choosing a long-term medication schedule.

The medication, treatment area, frequency, duration, and monitoring should be determined according to disease characteristics and relevant safety considerations.

A clear written treatment plan may help patients distinguish routine moisturizing from anti-inflammatory treatment during a flare and maintenance treatment between flares.

This can be especially useful when several topical preparations are prescribed or when different family members share responsibility for a child's care.

The value of a treatment plan lies in making care understandable and manageable, rather than simply increasing the number of instructions given.

Nonsteroidal and Advanced Treatments Have Important Roles

Topical corticosteroids are not the only effective anti-inflammatory treatments for atopic dermatitis.

Topical calcineurin inhibitors, including tacrolimus and pimecrolimus, are recommended options in appropriate circumstances.

They may be useful when a nonsteroidal alternative is preferred or when particular skin areas require additional consideration.

Other topical medicines, including phosphodiesterase-4 inhibitors and selected Janus kinase inhibitors, have evidence supporting their use in defined patient populations.

The American Academy of Dermatology's 2025 focused update added strong recommendations for several newer treatments, including tapinarof cream, roflumilast cream, lebrikizumab, and nemolizumab used with topical therapy in specified adult populations.

The 2026 pediatric guideline also includes recommendations for newer topical and systemic treatments.

However, a strong professional guideline recommendation does not mean that every medicine is suitable for every patient, approved for every age group, or available in all countries.

Regulatory approval, age restrictions, treatment indications, local availability, and monitoring requirements must be considered separately in Viet Nam.

For patients with moderate-to-severe disease that remains inadequately controlled despite appropriate topical treatment, specialist care may include phototherapy or systemic medication.

Biologic medicines and Janus kinase inhibitors have expanded treatment options, but their selection requires consideration of expected benefits, adverse effects, infection-related risks, comorbidities, and patient preferences.

Monitoring requirements differ between treatments. Some medicines require laboratory assessment or specific safety precautions, while others have different monitoring considerations.

Conventional systemic immunosuppressive medicines may also be appropriate for selected patients.

Importantly, international guidelines generally recommend against routine systemic corticosteroid use for atopic dermatitis because of safety concerns and the potential for disease recurrence or rebound after treatment withdrawal.

Short-term rescue or bridging therapy may be considered in exceptional circumstances by a specialist, but this should not be confused with routine or prolonged systemic corticosteroid treatment.

For VLMA, the purpose of discussing these treatments is to explain why appropriate escalation and medication safety matter, not to endorse particular pharmaceutical products or provide treatment protocols.

Food Elimination Diets Are Not Routine Atopic Dermatitis Treatment

Dietary restrictions are frequently discussed by patients and families managing atopic dermatitis.

Some parents remove milk, eggs, seafood, or several other foods from a child's diet because they suspect these foods are causing eczema.

Other patients follow restrictive diets promoted online as methods for reducing inflammation or repairing the skin barrier.

These approaches deserve careful evaluation.

Atopic dermatitis is associated with an increased likelihood of certain allergic conditions, including food allergy in some patients.

However, atopic dermatitis is not equivalent to food allergy, and the presence of eczema does not establish that a particular food is responsible for the condition.

The 2023 joint practice parameter from the American Academy of Allergy, Asthma and Immunology and the American College of Allergy, Asthma and Immunology conditionally recommends against routine elimination diets as treatment for atopic dermatitis.

The underlying evidence suggests that average improvements in eczema severity are small and uncertain, while dietary elimination can create important burdens and potential harms.

For children, unnecessary restriction may compromise nutritional adequacy, growth, and family routines.

Prolonged avoidance of previously tolerated foods may also have consequences for the development or maintenance of food tolerance in some circumstances.

Food-related anxiety and conflict around meals can create additional difficulties.

Routine food allergy testing may produce positive results that indicate sensitization rather than clinically significant food allergy.

Interpreting such results without considering the clinical history can lead to unnecessary dietary restrictions.

When a patient has a convincing history of an immediate reaction after eating a particular food, or another specific clinical indication for allergy assessment, appropriate investigation may be warranted.

This differs from ordering broad food allergy panels solely because atopic dermatitis is present.

It is also important to distinguish treatment of eczema from prevention of food allergy. Recommendations concerning the introduction of allergenic foods in infancy address different clinical outcomes and should not be interpreted as general advice to delay food introduction because a child has eczema.

Likewise, probiotics, nutritional supplements, restrictive eating patterns, and products marketed for skin or gut health should not be promoted as established treatments without adequate evidence.

A nutritionally adequate diet remains important for general health, but this does not demonstrate that eliminating particular foods will control inflammatory skin disease in every patient.

Recognizing Infection and Other Complications

Atopic dermatitis can increase vulnerability to certain skin infections because of impaired skin barrier function and changes in local immune responses.

However, bacterial colonization of eczematous skin is not equivalent to clinical infection.

Staphylococcus aureus may be present on the skin of patients with atopic dermatitis without requiring antibiotic treatment.

Antibiotics should not be used routinely simply because eczema is inflamed or recurrent.

Features suggesting secondary bacterial infection may include increasing pain, spreading inflammation, warmth, purulent discharge, crusting, fever, or rapid deterioration.

These findings require clinical assessment, particularly when the diagnosis is uncertain or the patient is systemically unwell.

The 2026 Singapore guideline recommends continuing appropriate anti-inflammatory treatment when secondary bacterial infection is present, alongside antimicrobial treatment when clinically indicated.

This recognizes that treatment may need to address both infection and underlying inflammation.

The same guideline advises against routine use of triple-combination preparations containing topical corticosteroids, antibiotics, and antifungals for suspected bacterial infection in atopic dermatitis.

An especially serious complication is eczema herpeticum, caused by herpes simplex virus infection affecting susceptible skin.

It may present with rapidly developing painful blisters, punched-out erosions, fever, or systemic symptoms.

Eczema herpeticum requires urgent medical evaluation and prompt antiviral treatment.

Lesions involving or near the eyes are particularly concerning because ocular involvement may threaten vision.

A rapidly worsening painful skin eruption should not automatically be dismissed as an ordinary eczema flare.

Likewise, patients should not be encouraged to intensify home remedies, use unprescribed combination creams, or delay medical assessment when concerning symptoms develop.

Appropriate education should support everyday self-care while ensuring serious complications are recognized early.

What Research From Viet Nam Shows About Moisturizing Practices

A study published on March 12, 2026, in the Journal of 108 – Clinical Medicine and Pharmacy examined knowledge, attitudes, and moisturizing practices among parents or guardians of children with atopic dermatitis.

The research was conducted at Ho Chi Minh City Hospital of Dermatology and Venereology and included 399 parents or guardians of children younger than 15 years.

Data were collected between March and September 2024.

The investigators reported that 87.7% of respondents knew moisturizing was necessary in managing atopic dermatitis, while 96.2% reported having used moisturizer for their children.

Among those who had used moisturizers, 59.6% reported stopping when the child's skin dryness improved.

The study also found that 67.9% expressed concerns about potential adverse effects of moisturizers.

This last finding should be interpreted accurately: the reported concern involved moisturizing products, not necessarily prescribed topical corticosteroids.

The results illustrate a gap between awareness and sustained behavior.

A caregiver may understand why moisturizing is useful but stop using it when symptoms improve. Others may be concerned about safety, struggle with cost, or find daily application inconvenient.

However, the study was cross-sectional and relied on responses from selected caregivers attending a specialized dermatology hospital.

It cannot establish that discontinuing moisturizer caused subsequent eczema flares or that a particular education intervention would improve clinical outcomes.

The findings also should not be generalized to all caregivers of children with atopic dermatitis in Viet Nam.

Nevertheless, the research identifies practical questions that deserve attention during clinical conversations.

Caregivers may need help understanding why ongoing moisturizing can remain useful after visible improvement, how to select an affordable and well-tolerated preparation, and how maintenance skin care differs from prescribed anti-inflammatory treatment.

These issues may influence whether evidence-based recommendations become part of everyday care.

Vietnamese Evidence on Itching and Quality of Life

Another study published in the Vietnam Medical Journal in June 2026 examined clinical characteristics and quality of life among adults with atopic dermatitis at Can Tho Dermatology Hospital and Can Tho University of Medicine and Pharmacy Hospital.

The cross-sectional study included 126 patients aged 18 years or older who had been diagnosed using modified Hanifin and Rajka criteria.

The mean age was 45.12 years, and 55.6% of participants were men.

Itching was reported by 97.6% of participants, making it one of the most prominent symptoms in the study population.

The mean Scoring Atopic Dermatitis index, known as SCORAD, was 33.78, and 57.1% of participants were classified as having moderate disease.

Using the Dermatology Life Quality Index, the investigators reported that 57.9% experienced substantial effects on quality of life.

Greater disease severity was statistically associated with worse quality-of-life scores.

These findings reinforce the importance of assessing more than the visible extent of skin lesions.

A patient may seek treatment because of persistent itching, disrupted sleep, discomfort at work, concerns about appearance, or difficulties maintaining daily activities.

However, the association between disease severity and quality of life does not establish that inflammation alone caused every reported difficulty.

Psychological well-being, concurrent illnesses, socioeconomic circumstances, and treatment experiences may also contribute.

Because the study involved selected patients at two healthcare facilities, it cannot establish national atopic dermatitis prevalence or demonstrate the effectiveness of a particular intervention.

Together with the caregiver study from Ho Chi Minh City, it provides locally relevant evidence about two complementary concerns: maintaining skin-care behaviors and recognizing the broader burden of the disease.

Vietnamese Professional Guidance Provides an Important Clinical Foundation

Viet Nam has an established national professional reference for dermatological diagnosis and treatment.

On December 6, 2023, the Ministry of Health issued Decision No. 4416/QĐ-BYT, introducing the Guidelines for Diagnosis and Treatment of Dermatological Diseases.

The document includes a dedicated section on atopic dermatitis, covering clinical manifestations, diagnostic criteria, differential diagnosis, treatment principles, and relevant management approaches.

It recognizes atopic dermatitis as a chronic, recurrent inflammatory skin disease and addresses treatment according to disease characteristics, appropriate topical medication, skin care, and education for patients and families.

This is important because international guidance should not be discussed as though no relevant Vietnamese professional recommendations exist.

The American Academy of Dermatology's 2025 and 2026 updates, the EuroGuiDerm living guideline, and Singapore's 2026 recommendations provide additional and more recent evidence concerning particular treatments and clinical questions.

However, these documents differ in their intended populations, regulatory settings, and treatment availability.

They may also reflect developments in clinical evidence since Viet Nam's 2023 guidance was issued.

For healthcare professionals in Viet Nam, the appropriate approach is to consider current international evidence alongside national professional guidance, applicable regulatory requirements, and the individual patient's clinical circumstances.

The Ministry of Health's guidance is a national professional reference for healthcare facilities. International clinical guidelines, while valuable, do not automatically replace it or establish that a particular medicine is registered, available, or reimbursed locally.

For VLMA, the educational contribution is to help healthcare professionals understand the evidence, recognize its limitations, and consider how it may be responsibly applied within Vietnamese healthcare practice.

Supporting Patients Beyond Written Instructions

Patient education is essential in managing atopic dermatitis, but education alone does not solve every difficulty with treatment.

A person may not understand when to apply moisturizer or a prescribed anti-inflammatory medicine. Another may understand the instructions but be unable to afford the recommended products.

A caregiver may worry about adverse effects, while a child may resist repeated application because a preparation stings or feels uncomfortable.

An adult may work in an environment where frequent handwashing, protective gloves, or exposure to irritating substances makes skin care particularly difficult.

These situations require different responses.

Healthcare professionals should ask patients what they actually do, which parts of treatment they find difficult, and what concerns influence their decisions.

Some families may benefit from clearer explanations of why moisturizing can remain important even when dryness improves. Others may need a more affordable product, a different formulation, simplified treatment instructions, or additional discussion about medication safety.

Written treatment plans may help distinguish daily maintenance care from treatment during flares.

Clear instructions are especially useful when several topical preparations are prescribed.

Patients should understand which preparation is intended for which area, how treatment changes when the skin improves, and when reassessment is necessary.

Education should also reflect age, health literacy, family circumstances, and available resources.

A more expensive imported product should not automatically be considered more effective or more appropriate than an affordable alternative with suitable properties.

Scientific independence requires healthcare professionals and organizations to discuss products according to evidence, safety, tolerability, and practical availability rather than commercial promotion.

The purpose of education is to support realistic and sustainable care, not to judge patients solely by whether they follow every instruction perfectly.

Measuring Improvement Beyond Visible Skin Lesions

The effectiveness of atopic dermatitis care should be evaluated through clinical findings and patient-reported outcomes.

The extent and severity of skin inflammation remain important.

Standardized instruments such as the Eczema Area and Severity Index and SCORAD can help assess disease activity and monitor treatment response.

However, these measures do not fully capture the patient's experience.

The Patient-Oriented Eczema Measure provides information about symptoms reported by patients, including itching, sleep disturbance, and other effects of the condition.

For adults, the Dermatology Life Quality Index can help assess the impact of skin disease on everyday life.

For children, age-appropriate instruments, including the Children's Dermatology Life Quality Index, may be relevant.

Caregiver burden may also deserve assessment, particularly when a young child's symptoms repeatedly disrupt family routines and sleep.

The choice of measurement instruments should reflect patient age, communication needs, the purpose of assessment, and the availability of appropriately validated language versions.

When international instruments are used in Viet Nam, healthcare organizations should consider whether suitable Vietnamese translations and validation are available.

Treatment evaluation should also consider flare frequency, medication tolerability, possible adverse effects, barriers to treatment, and the need for escalation.

Sleep outcomes may be meaningful in their own right.

A patient whose skin lesions improve but who continues waking repeatedly may need further assessment of itching, sleep disturbance, or another contributing condition.

Similarly, a treatment that produces improvement in clinical scores but remains unaffordable or too burdensome to maintain may provide limited practical benefit.

Healthcare professionals should ask whether patients can attend school, work, participate in family activities, and maintain ordinary routines with less discomfort.

For healthcare organizations, documenting that a cream was prescribed or a leaflet distributed is useful for assessing service delivery, but it does not establish that disease control has improved.

A responsible evaluation should connect care processes with symptoms, functional outcomes, treatment safety, and patient experiences.

Making Evidence-Based Atopic Dermatitis Care Practical in Viet Nam

Atopic dermatitis can be managed in different healthcare settings depending on disease severity, diagnostic certainty, and treatment requirements.

Primary care professionals may support patients with uncomplicated disease through appropriate assessment, education, maintenance skin care, and treatment within their legally authorized professional responsibilities.

More complex presentations may require dermatology consultation, particularly when the diagnosis is uncertain, disease is extensive, treatment response is inadequate, or systemic therapy is being considered.

Patients with suspected severe infection, eczema herpeticum, significant ocular involvement, or other concerning complications require timely medical assessment.

A practical care pathway should distinguish initial assessment, treatment of active inflammation, maintenance of skin barrier care, and reassessment when symptoms recur.

The Singapore 2026 guideline provides a useful example of organizing these elements for mild and moderate disease while incorporating patient preferences and follow-up.

However, its recommendations were developed for Singapore's healthcare system. Their application in Viet Nam must consider Vietnamese professional guidance, authorized medicines, available resources, and the circumstances of individual patients.

The same principle applies to newer biological and systemic treatments included in American and European guidelines.

International recommendations do not establish regulatory approval, reimbursement, or availability of a particular medicine in Viet Nam.

At the organizational level, quality improvement may begin with more consistent assessment of itching and sleep disturbance, clearer treatment instructions, better understanding of patient concerns, and appropriate referral pathways.

Healthcare teams can also review whether patients understand the difference between routine moisturizing, active anti-inflammatory treatment, and maintenance therapy.

These improvements may be more useful to patients than simply increasing the number of products or interventions offered.

Education should remain transparent about uncertainty. Even with appropriate skin care and effective treatment, some patients continue to experience flares.

Care should therefore involve ongoing assessment and shared decisions rather than suggesting that perfect lifestyle habits can prevent all disease activity.

Professional Responsibilities and Legal Boundaries in Viet Nam

Lifestyle Medicine can contribute to atopic dermatitis care through evidence-based skin-care education, support for healthy behaviors, recognition of relevant environmental exposures, and attention to sleep and psychological well-being.

However, diagnosing dermatological diseases, interpreting specialized investigations, prescribing medication, and managing severe atopic dermatitis or its complications are regulated healthcare activities requiring appropriate professional qualifications and authorization.

In Viet Nam, the Law on Medical Examination and Treatment No. 15/2023/QH15, together with applicable amendments and implementing regulations, provides the relevant legal framework.

Consolidated Document No. 26/VBHN-VPQH, issued by the Office of the National Assembly on February 26, 2026, reflects the consolidated provisions of the Law.

Healthcare professionals must act within their qualifications, competence, legally authorized scope of practice, and applicable institutional responsibilities.

Education or certification in Lifestyle Medicine does not independently authorize someone to diagnose atopic dermatitis, prescribe topical corticosteroids or systemic medication, interpret allergy tests as clinical diagnoses, or modify individualized treatment plans beyond their permitted professional responsibilities.

The Ministry of Health's Decision No. 4416/QĐ-BYT provides a relevant national clinical reference, while current international recommendations may inform evidence review, professional education, and clinical quality improvement.

These international recommendations do not automatically become Vietnamese regulatory requirements or establish the approval, availability, reimbursement, or suitability of particular medicines or treatments.

The Law on Disease Prevention No. 114/2025/QH15, effective July 1, 2026, provides a broader legal framework relevant to health promotion and disease prevention, but it does not independently authorize medical practice outside applicable licensing requirements.

Personal health information also requires appropriate safeguards.

Dermatological diagnoses, clinical photographs, treatment records, allergy histories, patient-reported outcomes, and other identifiable information must be handled according to applicable confidentiality and personal data protection obligations.

Viet Nam's Law on Personal Data Protection No. 91/2025/QH15 and Decree No. 356/2025/NĐ-CP, both effective January 1, 2026, are relevant to organizations processing identifiable personal health information.

Organizations collecting, using, storing, or sharing such information should establish appropriate lawful processing arrangements, security safeguards, and clearly defined responsibilities.

For the Vietnam Lifestyle Medicine Alliance, the appropriate contribution is professional education, scientific knowledge sharing, critical appraisal of evidence, and responsible communication about applying research in healthcare.

VLMA is a professional education and knowledge-sharing initiative, not a medical examination and treatment provider. Its educational articles should not be presented as official Vietnamese clinical treatment guidelines, individualized medical advice, or authorization to provide regulated healthcare services.

Connecting Skin Care, Sleep, and Treatment Safety

Atopic dermatitis demonstrates why evidence-based Lifestyle Medicine should not be reduced to advice about moisturizing, avoiding stress, or changing food habits.

Skin barrier care is foundational, but active inflammation often requires appropriate medical treatment.

Itching and disrupted sleep can substantially affect daily life, yet sleep-supporting behaviors and psychological interventions cannot replace control of the underlying skin disease.

Environmental exposures may worsen symptoms in selected patients, but identifying a trigger does not mean every flare can be prevented through avoidance.

Likewise, the evidence does not support routine food elimination diets, universal supplement recommendations, or commercial claims that a particular product can cure atopic dermatitis.

International guidance published and updated in 2025 and 2026 provides a stronger evidence base for individualized care, including newer treatment options for children and adults with more difficult disease.

Research from Viet Nam highlights the gap between awareness and sustained moisturizing practices, while also demonstrating how itching and disease severity are associated with reduced quality of life.

These findings reinforce the importance of asking patients whether they can maintain treatment, sleep comfortably, and participate in everyday activities rather than evaluating only the appearance of their skin.

For healthcare professionals in Viet Nam, an important opportunity is to strengthen the connection between appropriate skin barrier care, anti-inflammatory treatment, patient education, and continuing follow-up.

Lifestyle Medicine can support this process by helping people develop realistic health behaviors, address practical treatment barriers, and participate more effectively in long-term care.

For someone living with atopic dermatitis, meaningful improvement may involve fewer disruptive flares, more comfortable sleep, reduced itching, and greater confidence in managing the condition.

These outcomes depend on a care plan that combines evidence-based treatment with practical support and recognizes when specialist assessment is necessary.

The contribution of Lifestyle Medicine lies in helping patients maintain that care in everyday life, without delaying or replacing medically indicated dermatological treatment.

Selected References

1. American Academy of Dermatology. Guidelines of Care for the Management of Atopic Dermatitis in Adults With Topical Therapies. Journal of the American Academy of Dermatology. 2023;89(1)–e20. doi:10.1016/j.jaad.2022.12.029.

2. Davis DMR, et al. Focused Update: Guidelines of Care for the Management of Atopic Dermatitis in Adults. Journal of the American Academy of Dermatology. 2025;93(3):745.e1–745.e7. doi:10.1016/j.jaad.2025.05.1386.

3. Davis DMR, et al. Guidelines of Care for the Management of Atopic Dermatitis in Pediatric Patients. Journal of the American Academy of Dermatology. 2026;95(1):121.e1–121.e26. Published online April 7, 2026. doi:10.1016/j.jaad.2026.02.113.

4. Sidbury R, et al. Guidelines of Care for the Primary Prevention of Atopic Dermatitis and Awareness of Comorbid Conditions in Pediatric Atopic Dermatitis. Journal of the American Academy of Dermatology. 2026;95(1):124.e1–124.e19. doi:10.1016/j.jaad.2026.02.114.

5. EuroGuiDerm. Living EuroGuiDerm Guideline for the Systemic Treatment of Atopic Eczema. Updated April 2026.

6. Agency for Care Effectiveness, Singapore. Mild and Moderate Atopic Dermatitis (Eczema): A Journey From Flare to Care. Clinical Guideline. Published February 27, 2026; online version updated July 29, 2026.

7. Sidbury R, Wu PA, Alikhan A, et al. Guidelines for Diagnostic Testing in Adults With Presumed Atopic Dermatitis Refractory to Treatment. Journal of the American Academy of Dermatology. Published online August 31, 2026. doi:10.1016/j.jaad.2026.07.039.

8. Chu DK, et al. Atopic Dermatitis (Eczema) Guidelines: 2023 American Academy of Allergy, Asthma and Immunology/American College of Allergy, Asthma and Immunology Joint Task Force on Practice Parameters. Annals of Allergy, Asthma & Immunology. 2024;132(3):274–312. doi:10.1016/j.anai.2023.11.009.

9. Schoch JJ, Anderson KR, Jones AE, Tollefson MM. Atopic Dermatitis: Update on Skin-Directed Management. Pediatrics. 2025;155(6). doi:10.1542/peds.2025-071812.

10. Chen R, Miltner LA, Loman L, Schuttelaar MLA. Adults With Atopic Dermatitis and Atopic Multimorbidity Experience Impaired Sleep Quality. Journal of Investigative Dermatology. 2026;146(10):2896–2899. doi:10.1016/j.jid.2026.04.025.

11. Nguyễn Tầm Hoan, Lê Nguyễn Thủy Vy, Mai Phi Long, Châu Văn Trở. Khảo sát kiến thức, thái độ, hành vi sử dụng dưỡng ẩm của cha/mẹ hoặc người giám hộ trẻ em dưới 15 tuổi mắc viêm da cơ địa tại Bệnh viện Da liễu Thành phố Hồ Chí Minh. Tạp chí Y Dược Lâm sàng 108. 2026;21(2). Published March 12, 2026. doi:10.52389/ydls.v21i2.2967.

12. Huỳnh Anh Đào, Trương Ngọc Kim Châu, Nguyễn Thế Anh, et al. Nghiên cứu đặc điểm lâm sàng và khảo sát chất lượng cuộc sống ở bệnh nhân viêm da cơ địa người lớn tại Bệnh viện Da liễu Thành phố Cần Thơ và Bệnh viện Trường Đại học Y Dược Cần Thơ. Tạp chí Y học Việt Nam. 2026;561(2). doi:10.51298/vmj.v561i2.18245.

13. Rea BL, Cheema S, Lanza S, et al. Lifestyle Medicine Core Competencies: 2025 Update. American Journal of Lifestyle Medicine. 2026;20(3):443–451. First published online October 28, 2025. doi:10.1177/15598276251379821.

14. Ministry of Health of Viet Nam. Decision No. 4416/QĐ-BYT, dated December 6, 2023. Guidelines for Diagnosis and Treatment of Dermatological Diseases. Section on Atopic Dermatitis.

15. National Assembly of Viet Nam. Law No. 15/2023/QH15, dated January 9, 2023. Law on Medical Examination and Treatment. Effective January 1, 2024.

16. Office of the National Assembly of Viet Nam. Consolidated Document No. 26/VBHN-VPQH, dated February 26, 2026. Law on Medical Examination and Treatment.

17. National Assembly of Viet Nam. Law No. 114/2025/QH15, dated December 10, 2025. Law on Disease Prevention. Effective July 1, 2026.

18. National Assembly of Viet Nam. Law No. 91/2025/QH15, dated June 26, 2025. Law on Personal Data Protection. Effective January 1, 2026.

19. Government of Viet Nam. Decree No. 356/2025/NĐ-CP, dated December 31, 2025. Detailing Certain Articles and Measures for the Implementation of the Law on Personal Data Protection. Effective January 1, 2026.

Editorial, Clinical and Legal Disclaimer

This article is published by Vietnam Lifestyle Medicine Alliance (VLMA), a physician-led professional education and knowledge-sharing initiative operated by Vietnam Lifestyle Medicine Alliance Company Limited, for general information and professional education.

The article presents an evidence-informed discussion of Lifestyle Medicine in atopic dermatitis care. It does not constitute an official clinical practice guideline, individualized medical advice, a dermatological diagnosis, a medication prescription, a skin-treatment protocol, or authorization to undertake regulated medical activities.

The information must not be used to independently diagnose atopic dermatitis, prescribe or modify topical corticosteroid or systemic treatment, interpret allergy test results, initiate restrictive elimination diets, or determine an individualized treatment plan without appropriate professional assessment.

Skin barrier care, sleep-related support, environmental modifications, and other lifestyle-related interventions may complement treatment but must not replace medically indicated anti-inflammatory therapy or specialist assessment.

Patients and caregivers should not independently initiate potent topical corticosteroids, discontinue prescribed treatment, use unverified combination creams, or substantially alter a child's diet based solely on this article.

Rapidly worsening painful skin lesions, fever accompanied by widespread blisters or erosions, suspected eczema herpeticum, significant secondary infection, or lesions involving or near the eyes require prompt medical evaluation. Severe systemic illness may require emergency treatment.

International recommendations discussed in this article do not automatically constitute Vietnamese clinical standards or establish the regulatory approval, availability, reimbursement, or suitability of particular medicines, diagnostic tests, or treatments in Viet Nam.

All regulated medical activities must be undertaken by appropriately qualified healthcare professionals acting within their legally authorized scope of practice and the requirements governing healthcare facilities in Viet Nam.

This article does not endorse any commercial moisturizer, skin-care brand, supplement, elimination diet, pharmaceutical product, diagnostic service, or healthcare provider.

Identifiable personal health information, including clinical photographs and medical records, must be handled in accordance with applicable confidentiality and personal data protection requirements.

The content reflects the scientific evidence, professional recommendations, and legal sources reviewed as of October 31, 2026, and may require updating as further research, clinical guidance, and Vietnamese regulatory requirements evolve.