Eczema/Atopic Dermatitis

he 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 dermatitis is very common in all parts of the world. It affects about 10% of infants and 3% of the total population in the United States. It 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 throughout life, although not as severely as in early childhood.

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. Many babies improve before two years of age. Proper treatment can help until time solves the problem.

In teens and young adults, the patches 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 it 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 disease 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.

Q. Since this condition 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.

Q. 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.

Q. Are skin tests, like those given for hay fever or asthma, of any value in finding the causes?
A. Sometimes, but not as a rule. A positive test means allergy only about 20% of the time. If negative, the test is good evidence against allergy.

Q. 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.

Q. What should be done to treat this condition?
A. See your dermatologist for advice on avoiding irritating factors in creams and lotions; rough, scratchy, or tight clothing; and woolens. Rapid changes of temperature and any activity that causes sweating can aggravate atopic dermatitis. Proper bathing, moisturizing, and dealing with emotional upsets which may make the condition worse can be discussed. Your dermatologist can prescribe external medications such as steroids and newer immune modifying creams. Internal medications such as antihistamines can help with the itch. Oral antibiotics may be prescribed if there is a secondary infection. For severe cases, your dermatologist may recommend ultraviolet light treatment, or other treatments.