Eczema or dermatitis is a term used to describe a group of noncontagious,  inflamed skin conditions that result in chronic, relapsing and very itchy rashes. Atopic dermatitis is one type of eczema that usually starts in infancy or childhood.  Symptoms vary from person to person but often include dry or blistered, red, oozing, itchy patches on the skin.  In chronic cases, the patches can become thickened from scratching.    Eczema can range from minor to severe and can show up on any part of the body.    

Atopic Dermatitis or Atopic Eczema
The word “atopic” means there is a tendency for excess inflammation in the skin and linings of the nose and lungs. This often runs in families with allergies such as hay fever and asthma, sensitive skin, or a history of atopic dermatitis. Although most people with atopic dermatitis have family members with similar problems, 20% of them are the only ones in their family with the condition.

Atopic eczema is very common in all parts of the world. It affects about 10% of infants and 3% of the total population in North America. Atopic eczema can occur at any age but is most common in infants to young adults. The skin rash is very itchy and can be widespread or limited to a few areas. The condition frequently improves with adolescence, but many patients are affected by atopic eczema throughout life, although not as severely as in early childhood.

Infantile Eczema
When the disease starts in infancy, it is called infantile eczema. This is an itchy, oozing, crusting rash and occurs mainly on the face and scalp, but patches can appear anywhere. Because of the itch, children may rub their head, cheeks, and other patches with a hand, a pillow, or anything within reach. In many cases children eczema disappears before two years of age. Proper treatment can help until time solves the problem.

Eczema in Later Life
In teens and young adults, the patches of eczema typically occur on the hands and feet. However, any area such as the bends of the elbows, backs of the knees, ankles, wrists, face, neck, and upper chest may be affected. When eczema appears on the palms, backs of the hands, fingers, or on the feet, there can be episodes of crusting and oozing.  Other eczema patches in this stage are typically dry, red to brownish-gray, and may be scaly or thickened. The thickened areas may last for years without treatment. The intense, almost unbearable itching can continue, and may be most noticeable at night. Some patients scratch the skin until it bleeds and crusts. When this occurs, the skin can get infected.  Since the eczema does not always follow the same pattern, proper, early, and regular treatment can bring relief and may reduce the severity and duration of the disease.


Questions and Answers About Atopic Dermatitis

  1. Since the atopic dermatitis is associated with allergies, can certain foods be the cause?
    A. Rarely (perhaps 10%). Although some foods may provoke atopic dermatitis, especially in infants and young children with asthma, eliminating those foods is rarely a cure. You should eliminate any foods that cause immediate severe reactions or welts/hives.
  2. Are environmental causes important and should they be eliminated?
    A. Rarely. The elimination of contact or airborne substances does not bring lasting relief. Occasionally, dust and dust-catching objects like feather pillows, down comforters, kapok pillows and mattresses, cat and dog dander, carpeting, drapes, some toys, wool, and other rough fabrics, can worsen atopic dermatitis.
  3. Are skin tests, like those given for hay fever or asthma, of any value in finding the causes?
    A. Not usually. A positive test means allergy only about 20% of the time. If negative, the test is good evidence against allergy.
  4. Are “shots” such as those given for hay fever and other allergies, useful?
    A. Not usually. They may even make the skin condition worse in some patients.
  5. What should be done to treat eczema or  atopic dermatitis?
    See your dermatologist for advice on avoiding irritating factors in creams and lotions; rough, scratchy, or tight clothing; and woolens.

Softening your water may be helpful.

Rapid changes of temperature and any activity that causes sweating can aggravate atopic dermatitis.

Proper bathing and  moisturizing  (Aquaphor®, Vanicream®, CeraVe®, Cetaphil®, or Coconut Oil)

Dealing with emotional upsets which may make the condition worse can be discussed.  A cool mist humidifier in your bedroom is a good idea.

Your dermatologist can prescribe external medications such as steroids and newer non-steroid creams (e.g. Protopic, Elidel, Epiceram). Internal medications such as antihistamines can help with the itch when taken at night time.  Immunomodulators many be needed for very severe cases.   Oral antibiotics may be prescribed if there is a secondary infection.

We may prescribe a customized “eczema boot camp” for severe cases.

Occasional patch tests can be ordered for allergens in cases where a patient is not improving with treatments.

Atopic dermatitis is a very common condition. With proper treatment, the disease can be well-controlled in the majority of people.

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