Atopic Dermatitis (Eczema)

What is atopic dermatitis?

Atopic dermatitis (AD), also called eczema, is a hereditary and chronic skin disorder that is most common in infants or very young children and may last until the child reaches adolescence or adulthood.  Eczema causes the skin to itch, turn red, flake, and become tender.

Parents with eczema are more likely to have children with eczema.  However, the exact way it passes from parents to children is not known.  There is also an association with asthma and allergic rhinitis.  Of children who have eczema, most will show signs of the condition in the first year of life.  Ninety percent of people will develop eczema before their fifth birthday.  It is rare for eczema to develop in an adult with no childhood history.  Eczema is not contagious.

Different "trigger factors" can make eczema worse.  For example, the condition tends to flare up during times of stress, when the temperature is extremely high or low, when the person has a bacterial infection, or when the skin is irritated by fabrics (such as wool) or detergents.

What are the common locations and symptoms of eczema?

The location and 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 doctor for a diagnosis.

Treatment for eczema

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

• Your age, overall health, and medical history
• Extent of skin involved
• Your 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 doctor
• Take daily baths or showers using lukewarm water for 10-15 minutes
• Practice good skin care techniques
• Prevent infections
• Use lubricating cream or ointment at least once a day.  Fragrance-free moisturizers available in one pound jars include Aquaphor Ointment, Eucerin Cream, Vanicream, CeraVe Cream, or Cetaphil Cream.  Use moisturizers liberally throughout the day.  Moisturizers and sealers should not be applied over any topical medication.
• Dress in light clothes--sweating can make eczema worse
• Avoid scratching the affected area
• Minimize stress
   

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

Antihistamines.  These medications may help to decrease the amount of itching.  Some examples include diphenhydramine (Benadryl) or hydroxyzine (Atarax).  These medications may cause drowsiness, which can help with sleep.  This is considered one of the primary benefits of antihistamines as proper sleep is necessary for skin healing.  Some antihistamines are also available that do not cause drowsiness.  Consult your doctor for more information.

Steroid creams.  These topical medications help to decrease inflammation of the skin, thus decreasing the itching and swelling.  Topical steroids are among the most commonly used medications to reduce the signs and symptoms of eczema.  Many topical steroids in various strengths are available.  Steroids, if overused, are potentially damaging to the skin.  Consult your doctor for more information.

Systemic corticosteroids.  These medications given internally provide a potent reduction in inflammation, which can relieve itching.  They are reserved for only severe cases and can come in the form of a pill or liquid, or given as a shot.  There are significant side effects associated with the long term use of systemic corticosteroids, thus they are only used for a limited time. 

Oral antibiotics.  These medications kill bacteria known to cause infections in the setting of eczema.  Scratching the affected skin is a common way to introduce bacteria to the area leading to infection.  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.  It is important to take the antibiotic exactly as prescribed including the duration.  Early discontinuation of antibiotic therapy increases the risk for resistant bacteria to develop. 

Topical immunomodulator.  Topical immunomodulators are a class of drugs for the treatment of eczema.  These drugs are applied directly to the skin to alter the immune response.

There may be other appropriate treatment options available that can be discussed with your doctor.