Eczema (Atopic Dermatitis)

WHAT IS ATOPIC DERMATITIS?

Atopic dermatitis (also called eczema) is a common skin condition in which the skin is dry, red, and itchy. Most people develop atopic dermatitis during childhood – 60 percent or more develop it within the first year of life and at least 80 percent have the condition before age 5. While rare, atopic dermatitis can appear at puberty or later. Atopic dermatitis develops because the barrier function of your skin, which protects you from the environment, is not quite adequate. With a weakened barrier, it is easier for the “bad stuff” (bacteria and allergens) to get in and cause inflammation and infections and for the “good stuff” (water) to get out and cause dry, irritated skin. The skin of people with atopic dermatitis is also “hyper-excitable,” so the more you scratch, the more you itch!

WHY DO PEOPLE GET ATOPIC DERMATITIS?

People with a personal or family history of eczema, asthma, and seasonal allergies are more likely to have atopic dermatitis. There are also factors in the environment that can trigger or worsen atopic dermatitis. These factors include irritating soaps, dust mites, and pet dander.

HOW IS ATOPIC DERMATITIS DIAGNOSED?

Diagnosis is clinical. There is no blood test that can be done that would confirm the diagnosis of atopic dermatitis. Skin biopsy can help confirm the diagnosis but is only necessary if the clinical presentation is not typical.

WHAT IS THE NATURAL COURSE OF ATOPIC DERMATITIS?

Most children outgrow their atopic dermatitis. However, it can be a lifelong condition. For many, it tends to become less severe with age, often manifesting as rashes behind the elbows and knees, on the hands, feet, ankles, wrists, face, neck, and upper chest. For others, it is simply having lifelong “sensitive skin.”

PREVENTING ATOPIC DERMAITTIS

Keep the skin well moisturized. Avoid irritants and triggers. Use prescribed medications when there are red or rough areas to help the skin to return to normal as quickly as possible. Try to limit scratching!

TREATMENT

  1. Use moisturizer all over the entire body at least twice a dayMoisturizers help restore the barrier function that is weakened in your skin. Find a cream or ointment you like – this is most important because medicine doesn’t do much good in the bottle. The thicker the moisturizer, generally the better barrier it provides. If you put the moisturizer on your skin while it is still damp, it is doubly effective. The moisturizer provides a seal, holding water in the skin. Try to get the moisturizer on your skin within 3-5 minutes after getting out of the shower or bath. If you are using a medicated cream or ointment, apply it BEFORE your moisturizer.
  2. Apply prescription medications twice a day to only the red, rough areas on skinThere are two types of medicated creams used for atopic dermatitis: steroid creams and non-steroid creams (topical immunomodulators).
    • Steroid creams and ointments: The strength of the cream depends on the name of the active ingredient. The numbers at the end of the name do not indicate the relative strength (Triancinolone 0.1% ointment is MUCH stronger than hydrocortisone 1% cream). Topical steroids are very effective in treating atopic dermatitis. When used in the manner prescribed (only to areas of skin with rashes for not more than a few weeks at a time to any one area) they are very safe
    • Non-steroid creams and ointments (topical immunomodulators): Since they are newer, these medications are generally used as second-line medications, though they may be used alone or in conjunction with topical steroids. An advantage of these creams is that they do not have some of the side effects of misuse of steroids (thinning of skin and stretch marks when not used properly)
  3. Avoid triggersTriggers are different for different people. The most common triggers are:
    • Heat and sweat for some; cold weather for others
    • House dust mites, pet fur
    • Wool; synthetic fabrics like nylon; dyed fabrics
    • Tobacco smoke
    • Fragrances in: shampoos, soaps, laundry detergents
    • Prolonged water exposure
  4. Consider using a medication by mouth to help control the itchingScratching only makes you itch more and further disrupts the barrier function of your skin. Anti-itch medications can be used to help you resist the urge to scratch. There are different types of anti-itch medications – some cause more drowsiness than others. You may choose to use a non-sedating anti-histamine during the day (such as Zyrtec) and a sedating anti-histamine (such as Benadryl) to help sleep at night.
  5. More aggressive systemic medications for severe, difficult to control casesSystemic anti-inflammatory and immunosuppressive medications such as Prednisone, Cyclosporine, Methotrexate, or CellCept may be necessary for severe and difficult to treat cases. Additionally, people with atopic dermatitis frequently get secondary bacteria infections that make their rashes more difficult to control with their usual topical regimen. In these instances, a short course of oral antibiotics may be necessary to clear the infection and get things back under control.