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Atopic Dermatitis

What is eczema?

The word eczema is used to describe all kinds of red, blistering, oozing, scaly, brownish, thickened, and itching skin conditions.

The word “atopic” describes a group of allergic or associated diseases that often affect several members of a family. These families may have allergies such as hay fever and asthma but also have skin eruptions called atopic dermatitis. While most people with atopic dermatitis have family members with similar problems, 20% may be the only one in their family bothered by this problem.

The disease can occur at any age but is most common in infants to young adults. The skin rash is very itchy and sometimes disfiguring. The condition usually improves in childhood or sometime before the age of 25. About sixty percent of patients have some degree of dermatitis and some suffer throughout life. These cases can cause frustration to both the patient and the physician.

When the disease starts in infancy, it’s sometimes called infantile eczema. This itching, oozing, crusting condition tends to occur mainly on the face and scalp, although spots can appear elsewhere. In attempts to relieve the itching, the child may rub their head and cheeks and other affected areas with a hand, a pillow, or anything within reach. Parents should know that about 50% of babies improve before five years of age. Proper treatment can be helpful, sometimes controlling the disease until time solves the problem.

If the disease continues or occurs beyond infancy, the skin has less tendency to be red, blistering, oozing and crusting. Instead, the lesions become dry, red to brownish-gray, and the skin may be scaly and thickened. An intense, almost unbearable itching can continue, becoming severe at night. Some patients scratch at their skin until it bleeds and crusts. When this occurs, the skin may become infected.

In teens and young adults, the eruptions typically occur on the elbow bends and backs of the knees, ankles and wrists and on the face, neck and upper chest. Although these are the most common sites, any body area may be affected.

The disease does not always follow the usual pattern. It can appear on the palms or backs of the hands and fingers, or on the feet, where crusting, oozing, thickened areas may last for many years.

What causes eczema?

Although some foods may provoke attacks, especially in infants and young children, eliminating them rarely will bring about lasting improvement or a cure. A very important contributing factor is the family history of asthma, allergies, hay fever, and eczema . If all else fails, foods such as cow’s milk, soy, eggs, fish, wheat, peanuts and other foods that are suggested by your dermatologist can be avoided at least for one to two weeks on a trial basis.

Very rarely does the elimination of contact or airborne substances bring about lasting relief. Occasionally dust and dust-catching objects like feather pillows, down comforters, kapok pillows and mattresses, carpeting, drapes, some toys, and wool along with other rough fabrics, can cause the condition to worsen. In addition, testing for a low zinc level, which is involved in skin healing, may be necessary.

How can eczema be treated?

The cornerstone of atopic dermatitis treatment is adequate moisturization with either ointments such as Vaseline or aquaphor® or excellent moisturizing creams like Cetaphil® moisturizing cream. Lotions are not recommended. These moisturizers should be applied after medications and as many times per day as is necessary to continue sufficient moisturization. In terms of clothing, it is recommended that 100% cotton clothing be worn. Gentle laundry detergents such as Dreft ® or Unscented, undyed liquid detergents should be used. Fabric softener sheets are not recommended. Baths should be limited to one time per day and following bathing, the skin should be pat dried (leave water on the skin) and then the remaining water should be sealed in with the prescribed medication and moisturizer. Patients with atopic dermatitis should avoid contact with anyone with active cold sores or other herpes virus infections. Although many patients improve with increasing humidity, in some patients  sweating actually causes flaring of the condition. In these patients, maintaining a cool environment through the use of fans or other cooling instruments is essential.

External medications such as corticosteroids (cortisone) creams or ointments and internal medications such as antihistamines to control the itching can be prescribed. Newer medications that work similar to steroids but do not have the potential for steroid side effects may also be prescribed. It is vital that you follow the directions for these medications to not only improve the condition, but also prevent side effects. Oral antibiotics will be prescribed if there is also a secondary infection. For severe cases, your dermatologist may recommend ultraviolet light therapy or other oral medications.

Internally administered cortisone should be avoided if possible. However, when other measures have failed, your physician may prescribe systemic corticosteroids (cortisone) by pills or by an intramuscular injection.