ATOPIC DERMATITIS (eczema)
Atopic dermatitis (eczema) is a condition that makes your skin red and itchy. It’s common in children but can occur at any age. Atopic dermatitis is long lasting (chronic) and tends to flare periodically and then subside. It may be accompanied by asthma or hay fever.
No cure has been found for atopic dermatitis. But treatments and self-care measures can relieve itching and prevent new outbreaks. For example, it helps to avoid harsh soaps and other irritants, apply medicated creams or ointments, and moisturize your skin.
See your doctor if your atopic dermatitis symptoms distract you from your daily routines or prevent you from sleeping.
SYMPTOMS
Atopic dermatitis (eczema) signs and symptoms vary widely from person to person and include:
Itching, which may be severe, especially at night
Red to brownish-gray patches, especially on the hands, feet, ankles, wrists, neck, upper chest, eyelids, inside the bend of the elbows and knees, and, in infants, the face and scalp
Small, raised bumps, which may leak fluid and crust over when scratched
Thickened, cracked, dry, scaly skin
Raw, sensitive, swollen skin from scratching
Atopic dermatitis most often begins before age 5 and may persist into adolescence and adulthood. For some people, it flares periodically and then clears up for a time, even for several years.
Factors that worsen atopic dermatitis
Most people with atopic dermatitis also have Staphylococcus aureus bacteria on their skin. The staph bacteria multiply rapidly when the skin barrier is broken and fluid is present on the skin. This in turn may worsen symptoms, particularly in young children.
Factors that can worsen atopic dermatitis signs and symptoms include:
Dry skin, which can result from long, hot baths or showers
Scratching, which causes further skin damage
Bacteria and viruses
Stress
Sweat
Changes in heat and humidity
Solvents, cleaners, soaps and detergents
Wool in clothing, blankets and carpets
Dust and pollen
Tobacco smoke and air pollution
Eggs, milk, peanuts, soybeans, fish and wheat, in infants and children
Atopic dermatitis is related to allergies. But eliminating allergens is rarely helpful in clearing the condition. Occasionally, items that trap dust — such as feather pillows, down comforters, mattresses, carpeting and drapes — can worsen the condition.
When to see a doctor
See your doctor if:
You’re so uncomfortable that you are losing sleep or are distracted from your daily routines
Your skin is painful
You suspect your skin is infected (red streaks, pus, yellow scabs)
You’ve tried self-care steps without success
You think the condition is affecting your eyes or vision
Take your child to the doctor if you notice these signs and symptoms in your child or if you suspect your child has atopic dermatitis.
Seek immediate medical attention for your child if the rash looks infected and he or she has a fever.
CAUSES
The exact cause of atopic dermatitis (eczema) is unknown. Healthy skin helps retain moisture and protects you from bacteria, irritants and allergens. Eczema is likely related to a mix of factors:
Dry, irritable skin, which reduces the skin’s ability to be an effective barrier
A gene variation that affects the skin’s barrier function
Immune system dysfunction
Bacteria, such as Staphylococcus aureus, on the skin that creates a film that blocks sweat glands
Environmental conditions
RISK FACTORS
Factors that put people at increased risk of developing the condition include:
A personal or family history of eczema, allergies, hay fever or asthma
Being a health care worker, which is linked to hand dermatitis
Risk factors for children include:
Living in urban areas
Being African-American
Having parents with a high level of education
Attending child care
Having attention-deficit/hyperactivity disorder (ADHD)
COMPLICATIONS
Complications of atopic dermatitis (eczema) include:
Asthma and hayfever. Eczema sometimes precedes these conditions.
Chronic itchy, scaly skin. A skin condition called neurodermatitis (lichen simplex chronicus) starts with a patch of itchy skin. You scratch the area, which makes it even itchier. Eventually, you may scratch simply out of habit. This condition can cause the affected skin to become discolored, thick and leathery.
Skin infections. Repeated scratching that breaks the skin can cause open sores and cracks. These increase your risk of infection from bacteria and viruses, including the herpes simplex virus.
Eye problems. Signs and symptoms of eye complications include severe itching around the eyelids, eye watering, inflammation of the eyelid (blepharitis) and inflammation of the eyelid (conjunctivitis).
Irritant hand dermatitis. This especially affects people whose work requires that their hands are often wet and exposed to harsh soaps, detergents and disinfectants.
Allergic contact dermatitis. This condition is common in patients with atopic dermatitis. Many substances can cause an allergic skin reaction, including corticosteroids, drugs often used to treat people with atopic dermatitis.
Sleep problems. The itch-scratch cycle can cause you to awaken repeatedly and decrease the quality of your sleep.
Behavioral problems. Studies show a link between atopic dermatitis and attention-deficit/hyperactivity disorder, especially if a child is also losing sleep.
PREPARING FOR YOUR APPOINTMENT
You’re likely to start by seeing your family or primary care doctor. But in some cases when you call to set up an appointment, you may be referred to a specialist in skin diseases (dermatologist).
It’s good to prepare for your appointment. Here’s some information to help you get ready.
What you can do
List your signs and symptoms, when they occurred and how long they lasted. Also, it may help to list factors that triggered or worsened your symptoms — such as soaps or detergents, tobacco smoke, sweating, or long, hot showers.
Make a list of all the medications, vitamins, supplements and herbs you’re taking. Even better, take the original bottles and a written list of the dosages and directions.
List questions to ask your doctor. Ask questions when you want something clarified.
For atopic dermatitis, some basic questions you might ask your doctor include:
What might be causing my signs and symptoms?
Are tests needed to confirm the diagnosis?
What treatment do you recommend, if any?
Is this condition temporary or chronic?
Can I wait to see if the condition goes away on its own?
What are the alternatives to the primary approach you’re suggesting?
What skin care routines do you recommend to improve my symptoms?
What to expect from your doctor
Your doctor is likely to ask you several questions, including:
When did you begin having symptoms?
How often do you have these symptoms?
Have your symptoms been continuous or occasional?
What, if anything, seems to improve your symptoms?
What, if anything, appears to worsen your symptoms?
Do you or any family members have asthma or allergies?
What products do you use on your skin?
Does your condition affect your sleep or your ability to go about daily activities?
TESTS AND DIAGNOSIS
No lab test is needed to identify atopic dermatitis (eczema). Your doctor will likely make a diagnosis by examining your skin and reviewing your medical history. He or she may also use patch testing or other tests to rule out other skin diseases or identify conditions that accompany your eczema.
TREATMENTS AND DRUGS
Atopic dermatitis can be persistent. You may need to try various treatments over months or years to control it. And even if you respond to treatment, your signs and symptoms may return (flare).
It’s important to recognize the condition early so you can start treatment. If regular moisturizing and other self-care steps don’t help, your doctor may suggest the following treatments and drugs:
Medications
Creams that control itching and inflammation. Your doctor may prescribe a corticosteroid cream or ointment. Talk with your doctor before using any topical corticosteroid. Overuse of this drug may cause skin irritation or discoloration, thinning of the skin, infections, and stretch marks.
Creams that help repair the skin. Drugs called calcineurin inhibitors — such as tacrolimus (Protopic) and pimecrolimus (Elidel) — affect your immune system. Applied to the skin, they help maintain normal skin, control itching and reduce flares of atopic dermatitis. Due to possible side effects, these prescription-only drugs are used only when other treatments have failed or if someone can’t tolerate other treatments. They are approved for children older than 2 and for adults.
Drugs to fight infection. You may need antibiotics if you have a bacterial skin infection or an open sore or cracked skin caused by scratching. Your doctor may recommend taking oral antibiotics for a short time to treat an infection. Or he or she may suggest you take it for a longer time to reduce bacteria on your skin and to prevent another infection.
Oral anti-itch drugs. If itching is severe, oral antihistamines may help. Diphenhydramine (Benadryl, others) can make you sleepy and may be especially helpful at bedtime.
Oral or injected drugs that control inflammation. For more-severe cases, your doctor may prescribe oral corticosteroids — such as prednisone — or an injected corticosteroid. These drugs are effective but can’t be used long term because of potential serious side effects. Continue moisturizing and using other self-care remedies to prevent a flare-up after you stop taking the corticosteroids.
Therapies
Wet dressings. An effective, intensive treatment for severe atopic dermatitis involves wrapping the affected area with topical corticosteroids and wet bandages. It has proven to control signs and symptoms within hours to days. Sometimes it is done in a hospital because it’s labor intensive and requires nursing expertise. Or, ask your doctor about learning how to do this technique at home.
Light therapy. The simplest form of light therapy (phototherapy) involves exposing your skin to controlled amounts of natural sunlight. Other forms use artificial ultraviolet A (UVA) and narrow band UVB either alone or with medications.
Though effective, long-term light therapy has harmful effects, including premature skin aging and an increased risk of skin cancer. For these reasons, phototherapy is not used for infants and young children. Talk with your doctor about the pros and cons of light therapy in your situation.
Treatment for stress. Counseling may help children and young adults who are extremely embarrassed or frustrated by their skin condition.
Relaxation, behavior modification or biofeedback. These approaches may help you with habitual scratching.
Infantile eczema
Treatment for infantile eczema includes:
Identifying and avoiding skin irritations
Avoiding extreme temperatures
Lubricating your baby’s skin with bath oils, lotions, creams or ointments
See your baby’s doctor if these measures don’t improve the rash or if the rash looks infected. Your baby may need a prescription medication to control the rash or to treat an infection. Your doctor may recommend an oral antihistamine to help lessen the itch and to cause drowsiness, which may be helpful for nighttime itching and discomfort.
LIFESTYLE AND HOME REMEDIES
The following tips may help prevent bouts of dermatitis (flares) and minimize the drying effects of bathing:
Try to identify and avoid triggers that worsen the inflammation. Reduce your exposure to your unique triggers.
Take shorter baths or showers. Limit your baths and showers to 10 to 15 minutes. And use warm, rather than hot, water. Bath oil also may be helpful.
Use only gentle soaps. Choose mild soaps that clean without removing too many natural oils. Deodorant and antibacterial soaps may be more drying to your skin. Use soap only on your face, underarms, genital areas, hands and feet. Use clear water elsewhere.
Dry yourself carefully. After bathing, brush your skin rapidly with the palms of your hands, or gently pat your skin dry with a soft towel and apply moisturizer.
Moisturize your skin at least twice a day. Creams or lotions seal in moisture. Thicker moisturizers work best — such as Cetaphil, Nutraderm and Eucerin. You may also want to use cosmetics that contain moisturizers. If your skin is extremely dry, try applying baby oil or a similar product while your skin is still moist. Oil has more staying power than moisturizers do.
ALTERNATIVE MEDICINE
Many alternative medicine therapies have helped some people manage their atopic dermatitis. One study showed that people who used Chinese herbal medications experienced reduced itching and other symptoms, but only temporarily. Another showed that four weeks of acupressure resulted in reduced itching and scaling.
Evidence for the following approaches isn’t conclusive:
Dietary supplements, such as vitamins D and E, zinc, selenium, evening primrose oil, borage seed oil, oolong tea, probiotics
Other plant-based therapies, including St. John’s wort, calendula flowers, tea tree oil, German chamomile, Oregon grape root, licorice, rice bran broth (applied to the skin)
Acupuncture
Aromatherapy
Bath therapy
Use of electrodes to change electromagnetic waves of the body (bioresonance)
Therapeutic use of color, light and relaxation techniques (chromotherapy)
Homeopathy
Massage therapy
If you’re considering dietary supplements or other alternative therapies, talk with your doctor about their pros and cons.
COPING AND SUPPORT
Atopic dermatitis can be especially stressful, frustrating or embarrassing for adolescents and young adults. It can disrupt their sleep and even lead to depression. And close family members of people with this condition may face financial, social and emotional problems.
Seek psychological support from family, counselors or support groups