Eczema/Atopic Dermatitis
The word eczema describes certain kinds of dermatitis
(inflamed skin). Early eczema can be red, blistering, or oozing. Later on,
eczema can be scaly, brownish, or thickened. Almost always, eczema itches.
Examples of eczema include allergic contact dermatitis, seborrheic dermatitis,
and nummular dermatitis. This pamphlet will describe and discuss a special type
of eczema called atopic dermatitis or atopic eczema.
Atopic Dermatitis or Atopic Eczema
The word "atopic" refers to a tendency for excess inflammation in the skin,
linings of the nose, and lungs. It often runs in families. These families may
have allergies such as hay fever and asthma, but can also have sensitive skin
and a history of eruptions called atopic dermatitis. While most people with
atopic dermatitis have family members with similar problems, 20 percent of
patients may be the only one in their family bothered by this condition.
Atopic dermatitis is very common in all parts of the world. It affects about ten
percent of infants and three percent of all people in the United States.
The disease 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 in childhood or at least before age 25. About
50 percent of patients are affected throughout life, although not as severely as
during early childhood. Atopic dermatitis cases can cause frustration to both
the patient and the physician.
When the disease starts in infancy, it's often called infantile eczema. The
itchy rash is an oozing, crusting condition that 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.
Infantile Eczema/Atopic Dermatitis
After infancy, the skin tends to be less red, blistering, oozing, or crusting.
Instead, the patches are dry, red to brownish-gray, and may be scaly or
thickened. 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.
In teens and young adults, the patches typically occur on the hands and feet.
Although these are the most common sites, any area such as the bends of the
elbows, backs of the knees, ankles, wrists, face, neck, and upper chest may also
be affected.
Eczema/Atopic Dermatitis
Recognizing Atopic Dermatitis
An itchy rash as described above, along with a family history of atopic
problems, may indicate atopic dermatitis. Proper, early, and regular treatment
can bring relief and may also reduce the severity and duration of the disease.
The disease does not always follow the usual pattern. It can appear on the
palms, backs of the hands and fingers, or on the feet, where crusting, oozing,
thickened areas may last for years.
Questions and Answers About Atopic Dermatitis
Q. Since this condition is associated with allergies; can certain foods be
the cause?
A. Yes, but only rarely (perhaps 10 percent). Although some foods may provoke
atopic dermatitis, especially in infants and young children with asthma,
eliminating them rarely will be a cure. Foods that cause immediate severe
reactions or welts, should be avoided. Unless you are under a doctor's
supervision, you should limit trials of certain foods to one food at a time, for
no longer than two weeks.
Q. Are environmental causes important and should they be eliminated?
A. Rarely does the elimination of contact or airborne substances bring about
lasting relief. Occasionally, dust and dust-catching objects (feather pillows,
down comforters, kapok pillows, mattresses, 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
percent of the time. If negative, the test is a good evidence against allergy.
If these tests are desired, ask your dermatologist to recommend someone who has
experience.
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 then 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. Seek advice from your dermatologist about proper bathing,
moisturizing, and dealing with emotional upsets which may make the condition
worse.
Your dermatologist can prescribe external medications such as cortisone creams,
ointments on lotions and sometimes tars. Internal medications such as
antihistamines can help deal with the itch. Oral antibiotics may be prescribed
if there is also a secondary infection. For severe cases, your dermatologist may
recommend ultraviolet light treatments. There are several newer types of
medications that may be helpful for patients when standard treatment doesn't
work.
Internal cortisone should be avoided if possible. However, when other measures
have failed, your physician may prescribe cortisone in the form of pills or an
injection.
Eczema/Atopic Dermatitis
It has been 40 years since a new class of topical medications specifically for
this disease has been introduced. However, a new class of drugs called topical
immunomodulators (TIMs) will soon be available that show promise in the
treatment of moderately severe eczema. Two TIMs in development, tacrolimus and
ascomycin, are steroid-free. Tacrolimus is likely to be the first TIM approved
and available in the United States. Studies have shown that this new class of
drugs will improve or completely clear eczema in more than 80 percent of treated
patients, with an improved side-effect profile compared with topical steroids.
Atopic dermatitis is a very common condition. With proper treatment, the disease
can be controlled in the majority of people.
Support Groups
The National Eczema Association for Science and Education works to improve the
health of people living with eczema. www.eczema-assn.org
The National Eczema Society is a worldwide organization dedicated to the needs
of people with eczema, dermatitis, and sensitive skin. Based in the United
Kingdom, they can provide information and encouragement for children in the
11-16 age group. www.eczema.org
