ATOPIC DERMATITIS (ECZEMA)
Definition:
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. It may be accompanied by asthma or hay fever.
Description:
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, moisturize your skin regularly, and apply medicated creams or ointments.
Atopic dermatitis (eczema) signs and symptoms vary widely from person to person and include:
- Dry skin
- 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, 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.
When to see a doctor
See a doctor if you or your child:
- Is so uncomfortable that the condition is affecting sleep and daily activities
- Has a skin infection — look for red streaks, pus, yellow scabs
- Continues to experience symptoms despite trying home remedies
Seek immediate medical attention for your child if the rash looks infected and he or she has a fever.
Causes
Healthy skin helps retain moisture and protects you from bacteria, irritants and allergens. Eczema is related to a gene variation that affects the skin's ability to provide this protection. This allows your skin to be affected by environmental factors, irritants and allergens.
In some children, food allergies may play a role in causing eczema.
Risk factors
The primary risk factor for atopic dermatitis is having a personal or family history of eczema, allergies, hay fever or asthma.
Complications
Complications of atopic dermatitis (eczema) may include:
- Asthma and hay fever. Eczema sometimes precedes these conditions. More than half of young children with atopic dermatitis develop asthma and hay fever by age 13.
- 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 the risk of infection from bacteria and viruses, including the herpes simplex virus.
- 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 people with atopic dermatitis.
Sleep problems. The itch-scratch cycle can cause poor sleep quality.
Prevention
The following tips may help prevent bouts of dermatitis (flares) and minimize the drying effects of bathing:
- Moisturize your skin at least twice a day. Creams, ointments and lotions seal in moisture. Choose a product or products that work well for you. Using petroleum jelly on your baby's skin may help prevent development of atopic dermatitis.
- Try to identify and avoid triggers that worsen the condition. Things that can worsen the skin reaction include sweat, stress, obesity, soaps, detergents, dust and pollen. Reduce your exposure to your triggers.
- Infants and children may experience flares from eating certain foods, including eggs, milk, soy and wheat. Talk with your child's doctor about identifying potential food allergies.
- Take shorter baths or showers. Limit your baths and showers to 10 to 15 minutes. And use warm, rather than hot, water.
- Take a bleach bath. The American Academy of Dermatology recommends considering a bleach bath to help prevent flares. A diluted-bleach bath decreases bacteria on the skin and related infections. Add 1/2 cup (118 milliliters) of household bleach, not concentrated bleach, to a 40-gallon (151-liter) bathtub filled with warm water. Measures are for a U.S.-standard-sized tub filled to the overflow drainage holes.
- Soak from the neck down or just the affected areas of skin for about 10 minutes. Do not submerge the head. Take a bleach bath no more than twice a week.
- Use only gentle soaps. Choose mild soaps. Deodorant soaps and antibacterial soaps can remove more natural oils and dry your skin.
- Dry yourself carefully. After bathing gently pat your skin dry with a soft towel and apply moisturizer while your skin is still damp.
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.
If you suspect a certain food caused your child's rash, tell the doctor and ask about identifying potential food allergies.
Treatment
Atopic dermatitis can be persistent. You may need to try various treatments over months or years to control it. And even if treatment is successful, signs and symptoms may return (flare).
It's important to recognize the condition early so that you can start treatment. If regular moisturizing and other self-care steps don't help, your doctor may suggest one or more of the following treatments:
Medications
- Creams that control itching and help repair the skin. Your doctor may prescribe a corticosteroid cream or ointment. Apply it as directed, after you moisturize. Overuse of this drug may cause side effects, including thinning skin.
Other creams containing drugs called calcineurin inhibitors — such as tacrolimus (Protopic) and pimecrolimus (Elidel) — affect your immune system. They are used by people older than age 2 to help control the skin reaction. Apply it as directed, after you moisturize. Avoid strong sunlight when using these products.
These drugs have a black box warning about a potential risk of cancer. But the American Academy of Allergy, Asthma & Immunology has concluded that the risk-to-benefit ratios of topical pimecrolimus and tacrolimus are similar to those of most other conventional treatments of persistent eczema and that the data don't support the use of the black box warning.
- Drugs to fight infection. Your doctor may prescribe an antibiotic cream if your skin has a bacterial infection, an open sore or cracks. He or she may recommend taking oral antibiotics for a short time to treat an infection.
- Oral drugs that control inflammation. For more-severe cases, your doctor may prescribe oral corticosteroids — such as prednisone. These drugs are effective but can't be used long term because of potential serious side effects.
- Newer option for severe eczema. The Food and Drug Administration (FDA) has recently approved a new, injectable biologic (monoclonal antibody) called dupilumab (Dupixent). It is used to treat people with severe disease who do not respond well to other treatment options. This is a newer medication, so it doesn't have a long track record in terms of how well it helps people. Studies have shown it to be safe if used as directed. It is very expensive.
Therapies
- Wet dressings. An effective, intensive treatment for severe atopic dermatitis involves wrapping the affected area with topical corticosteroids and wet bandages. Sometimes this is done in a hospital for people with widespread lesions because it's labor intensive and requires nursing expertise. Or, ask your doctor about learning how to do this technique at home.
- Light therapy. This treatment is used for people who either don't get better with topical treatments or who rapidly flare again after treatment. The simplest form of light therapy (phototherapy) involves exposing the skin to controlled amounts of natural sunlight. Other forms use artificial ultraviolet A (UVA) and narrow band ultraviolet B (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 less commonly used in young children and not given to infants. Talk with your doctor about the pros and cons of light therapy.
- Counseling. Talking with a therapist or other counselor may help people who are embarrassed or frustrated by their skin condition.
- Relaxation, behavior modification and biofeedback. These approaches may help people who scratch habitually.
Infant eczema
Treatment for eczema in babies (infantile eczema) includes:
- Identifying and avoiding skin irritants
- Avoiding extreme temperatures
- Lubricating your baby's skin with bath oils, 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 also 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
To help reduce itching and soothe inflamed skin, try these self-care measures:
- Moisturize your skin at least twice a day. Find a product or combination of products that works for you. You might try bath oils, creams, ointments or sprays. For a child, the twice-a-day regimen might be an ointment before bedtime and a cream before school. Ointments are greasier and sting less when applied.
- Apply an anti-itch cream to the affected area. A nonprescription hydrocortisone cream, containing at least 1 percent hydrocortisone, can temporarily relieve the itch. Apply it no more than twice a day to the affected area, after moisturizing. Using the moisturizer first helps the medicated cream penetrate the skin better. Once your reaction has improved, you may use this type of cream less often to prevent flare-ups.
- Take an oral allergy or anti-itch medication. Options include nonprescription allergy medicines (antihistamines) — such as cetirizine (Zyrtec) or fexofenadine (Allegra). Also, diphenhydramine (Benadryl, others) may be helpful if itching is severe. But it causes drowsiness, so it's better for bedtime.
- Don't scratch. Rather than scratching when you itch, try pressing on the skin. Cover the itchy area if you can't keep from scratching it. For children, it might help to trim their nails and have them wear gloves at night.
- Apply bandages. Covering the affected area with bandages helps protect the skin and prevent scratching.
- Take a warm bath. Sprinkle the bath water with baking soda, uncooked oatmeal or colloidal oatmeal — a finely ground oatmeal that is made for the bathtub (Aveeno, others). Soak for 10 to 15 minutes, then pat dry. Apply moisturizer while the skin is still damp.
- Choose mild soaps without dyes or perfumes. Use soap that's superfatted and nonalkaline. Be sure to rinse off the soap completely.
- Use a humidifier. Hot, dry indoor air can parch sensitive skin and worsen itching and flaking. A portable home humidifier or one attached to your furnace adds moisture to the air inside your home.
- Wear cool, smooth-textured clothing. Reduce irritation by avoiding clothing that's rough, tight or scratchy. Also, wear appropriate clothing in hot weather or during exercise to prevent excessive sweating.
- Treat stress and anxiety. Stress and other emotional disorders can worsen atopic dermatitis. Acknowledging those and trying to improve your emotional health can help.
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 counselors, support groups, friends or family.
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).
Here's some information to help you prepare for your appointment.
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 are your hobbies?
- Do you come in direct contact with pets or animals? What products do you use on your skin?
- Does your condition affect your sleep or your ability to go about your daily activities?