Atopic Dermatitis (Eczema)

What is atopic dermatitis?

Atopic dermatitis, also called eczema, is a hereditary and chronic skin disorder that mostly affects infants or very young children, and may last until the child reaches adolescence or adulthood. Eczema causes the skin to itch, turn red, and flake.

Parents with eczema are more likely to have children with eczema. Different triggers can make eczema worse, including environmental irritants, allergies, and stress.

The condition tends to flare up during times of stress, when the temperature is extremely high or low, when the patient has a bacterial infection, or when the skin is irritated by fabrics (wool) or detergents. Of children who have eczema, 65 percent will show signs of eczema in the first year of life and 90 percent will show signs of eczema within the first 5 years.

What are the symptoms of eczema?

The distribution of eczema may change with age. In infants and young children, eczema is usually located on the face, outside of the elbows, and on the knees. In older children and adults, eczema tends to be on the hands and feet, the arms, and on the back of the knees. The following are the most common symptoms of eczema. However, each person may experience symptoms differently. Symptoms may include:

• dry, scaly skin
• small bumps that open and weep when scratched
• redness and swelling of the skin
• a thickening of the skin (with chronic eczema)

Excessive rubbing and scratching can tear the skin and result in an infection. The symptoms of eczema may resemble other skin conditions. Always consult your physician for a diagnosis.

How is eczema diagnosed?

Atopic dermatitis is very common. Over 15 million American adults and children have atopic dermatitis. The National Institute of Arthritis and Musculoskeletal and Skin Diseases estimates that at least 20 percent of infants and children experience symptoms of atopic dermatitis. In addition to a complete medical history and physical examination, diagnostic procedures for eczema may include the following:

• family history (Children born to a mother who has allergic conditions are more prone to eczema.)
  
  
• personal history of allergies or asthma
  
  
• blood tests

Treatment for eczema:

Specific treatment for eczema will be determined by your physician based on:

• your (your child's) age, overall health, and medical history
• extent of the reaction
• your (your child's) tolerance for specific medications, procedures, or therapies
• expectations for the course of the reaction
• your opinion or preference

There is no cure for eczema. The goals of treatment are to reduce itching and inflammation of the skin, moisturize the skin, and prevent infection.

Management of eczema symptoms:

The following are suggestions for the management of eczema:

• Avoid contact with irritants, as determined by your physician.
  
  
• Take brief baths or showers using lukewarm water.
  
  
• Practice good skin care techniques.
  
  
• Do not use harsh soaps. Ask your physician to recommend a brand.
  
  
• Dress in light clothes - sweating can make eczema worse.
  
  
• Use lubricating lotions at least once a day. Ask your physician to recommend a brand.
  
  
• Avoid scratching the affected area.
  
  
• Minimize stress.

Your physician may also prescribe medications in severe cases. The following medications are most commonly used to treat eczema:

• antihistamines - These medications help to decrease the amount of itching. Some examples are diphenhydramine (Benadryl®) or hydroxyzine (Atarax®). These medications may cause drowsiness. Some new antihistamines are also available that do not cause drowsiness. Consult your physician for more information.

• steroid creams - These topical medications help to decrease the inflammation in the skin, thus, decreasing the itching and swelling. This helps with itching and swelling. Many topical steroids in various strengths are available. Steroids, if overused, are potentially damaging to the skin. Follow the advice of your physician.

• oral antibiotics - These medications are derived from mold or bacteria and slow the growth of specific micro-organisms. A sample from the body part thought to be infected may be taken and cultured in a lab to determine what type of antibiotic to use for the most effective treatment. Follow the instructions for dosing and administration carefully and consult with your physician as needed.

• oral cyclosporin - This medication is used primarily to prevent rejection after organ transplantation. It suppresses the immune system and has other side effects that should be considered. Consult with your physician as needed.

• phototherapy (light therapy) - It is safest to have this treatment under medical supervision, but light therapy is not offered at all dermatology clinics. Home light therapy devices are available, but the cost may not be covered by insurance. Narrow band UVB (ultraviolet B) light units are the most effective. Be sure to follow the manufacturer's instructions carefully to avoid injury.

• topical immunomodulators (TIMs) - Topical immunomodulators are a new class of drugs for the treatment of eczema. These drugs are applied directly to the skin to alter the immune response.