What is Atopic Dermatitis? (Part 1)

Atopic dermatitis, or eczema, is often described as “the itch that rashes”. It is an extremely common rash. It occurs in about 10 to 20 percent of children under the age of 10 in the United States and about one to three percent of adults in the world. It affects at least 28 million people in the U.S. alone.

Eczema usually presents itself in childhood. 60 percent of patients with eczema develop it before they are one year of age, and 90 percent develop it before they are five years old. However, some patients do develop eczema later in life. Atopic dermatitis is characterized by areas of intense itching. Children with eczema will often rub their skin against their bedding, carpeting, or other things. The itching can be so severe that children may have trouble sleeping.

Eczema characteristically involves the scalp, face, neck, and the insides of the elbows, knees, and ankles. The involved areas are dry, red, and sometimes scaly. Scratching can lead to a secondary infection. In long-standing eczema, the skin may lighten or darken. The skin may also thicken or appear leathery.

Atopic dermatitis is a chronic condition. It often comes and goes for many years. For most people, however, the symptoms will ultimately improve by adolescence or adulthood. Atopic dermatitis is much more common today than it was 30 years ago. Dermatologists are not sure why this is. We do know that there are certain factors that increase a child’s risk of getting eczema. These risk factors are:

• Family history of eczema, asthma, or hay fever
• Living in a developed country, living in a city (especially if there are high levels of pollution), or living in a cold climate
• Females are more likely to have atopic dermatitis than males

Studies suggest that food allergies do not cause atopic dermatitis, but certain foods (milk, nuts, shellfish) can make eczema worse. The dermatologist or allergist may perform food allergy tests.

Eczema is a chronic condition. At times, the rash may be better or even gone, while at other times the rash may flare up with severe symptoms. The management of eczema must reflect this—at times, the treatments must be more intense, and at other times, simple measures will do the trick. The management, like the disease, is chronic.

Prevention

Prevention is one of the most important parts of managing eczema.  The measures that I list below may seem very simple, but they are crucial.

• Use a gentle cleanser to wash yourself. Do not use harsh soaps.
• Moisturize at least once per day. Use a thick hypoallergenic moisturizer. Recent studies have demonstrated the importance of ceramides for atopic dermatitis. I prefer a cream with ceramides. The best time to moisturize is right after a shower or bath, after pat drying, when the skin is still a little wet. This will “trap” the moisture in.
• Avoid fragrance or scented products.
• Use a hypoallergenic laundry detergent.
• Avoid dryer sheets or fabric softeners.
• Use hypoallergenic mattress and pillow covers.
• Wear soft clothing that does not scratch your skin.
• Avoid things that flare your eczema. For some people, this is pets, grass or carpeting. For others, it may be certain foods. Please consult your doctor before changing your diet.

Treatment

Treatment of mild atopic dermatitis (mild itching or rash):

• Increase frequency of moisturizing.
• Over-the-counter anti-itch creams or gels can help alleviate the itch and may help prevent a worsening of the eczema.
• Over-the-counter steroid creams.
• Prescription strength non-steroid creams (elidel, protopic, epicerum, atopiclair and mimyx).
• Mild prescription-strength topical steroids.
• Antihistamine pills/syrup before bed.

Treatment of moderate or severe atopic dermatitis:

• Increase frequency of moisturizing.
• Anti-itch creams.
• Prescription-strength topical steroids.
• Antihistamine pills/syrup before bed.
• See below for other treatments and considerations.

Other Considerations

Sometimes, there may be a secondary bacterial or fungal infection. Your doctor can diagnose this. Symptoms of a secondary infection include pain, flare of the rash or yellow crusting. These should be treated properly with topical or oral medicines from your doctor.

Other Treatments

Sometimes, eczema is very severe, or cannot be controlled by the measures above. In those more severe cases, doctors can prescribe oral medications to help. In addition, there are light treatments that may be done in the doctor’s office.

Managing eczema can be difficult, and patients need to learn when their skin is clear, flaring or not responding to treatment. Treatment will depend on the current severity of eczema.