Atopic Dermatitis (Eczema)

Overview

By Sarah Maurer

Eczema is a catchall word for a number of skin conditions that cause a very itchy, red rash.

The most common form of eczema is atopic dermatitis, or AD. People with AD develop an intensely itchy skin rash that tends to come and go over time. It can affect any part of the body, but is most common on the neck, wrists, ankles, hands and the insides of the knees and elbows. Babies and young children young children with AD usually develop a rash on their faces and scalps.

AD isn't contagious, and it's usually not dangerous in itself. However, the intense itching makes it very uncomfortable to live with. Scratching the rash only intensifies the inflammation and can also cause complications like skin infections. Over time, scratching can cause thick, discolored patches to form on the skin – a condition called neurodermatitis. In rare cases, severe eczema on the face can cause permanent damage to the eyes. Treating AD early and practicing good skin care is essential to prevent these problems from developing.

AD affects an estimated 17 million people in the United States, including about 10-20 percent of children and 1-3 percent of adults. Most cases appear before age five, and about half continue into adulthood.

Causes and Risk Factors

No one knows exactly what causes atopic dermatitis, but research suggests that inherited sensitivities of the skin and immune system play a role.

Some experts believe AD is related to other atopic (allergic) conditions like hay fever and asthma. About half of all people with AD eventually develop one of these conditions, and many have close family members with these allergies.

AD "flares" are usually set off by certain triggers that differ from person to person. Many substances in the environment (called irritants) can trigger a rash in susceptible people, including:

  • Soaps and laundry detergents
  • Cigarette smoke
  • Cleaning products
  • Smog and environmental pollutants
  • Dust or sand
  • Rough fabrics (for example, wool)
  • Acidic foods (for example, fruit juice)
  • Skin care and products (especially those containing alcohol or fragrance).

Other possible triggers include:

  • Stress
  • Hormonal changes
  • Dry skin
  • Sweating
  • Hot weather
  • Extreme humidity (both high and low)
  • Infections.

There's evidence that AD flare-ups can be worsened by allergies, which are sensitivities to environmental substances like foods, pollen, pets, and dust mites. Exposure causes the allergic person's immune system to respond as it would to a dangerous substance like bacteria. Immune cells rush to the skin and release inflammatory chemicals that cause swelling, itching and redness.

Symptoms

example of eczema on arms

The AD rash varies from person to person, and can even look different on different body parts of the same person. Common signs include:

  • Patches of discolored skin that range from red to grayish-brown. The rash may appear suddenly.
  • Itching, which may be quite intense, especially at night.
  • Little raised bumps that may ooze fluid or crust over.
  • Patches of scaly, thickened, or leathery skin.
  • Raw or sensitive spots caused by scratching.

Atopic dermatitis usually recurs in flare-ups with symptom-free periods in between. These "remissions" can last weeks, months, or even years.

Diagnosis and Treatment

Some eczema flares can be treated at home, but see a doctor if:

  • You notice AD symptoms for the first time.
  • The condition interferes with your normal activities.
  • You're having trouble sleeping.
  • The rash is painful.
  • You think your skin may be infected.
  • You have severe rash around the eyes or swelling of the eyelids.

AD is usually diagnosed by history and physical examination. There is no definitive test for the condition. Allergy tests (blood tests, scratch tests) are sometimes used to identify potential triggers.

If AD is suspected, your physician may refer you to a dermatologist or allergist for specialized diagnosis and treatment.

At present, there is no cure for atopic dermatitis. The goals of treatment are to relieve discomfort, prevent complications and minimize future flares.

The best thing people with AD can do for their condition is to practice good skin care. Not only does it help prevent flares, it makes all other treatments more effective. Some essential skin care steps:

  • Take regular warm (not hot) baths.
  • Cleanse your skin gently with a mild soap. Do not scrub.
  • After getting out, pat your skin dry with a soft towel.
  • Apply a good moisturizer within a few minutes of exiting the water.

Mild AD rash sometimes responds to over-the-counter creams and antihistamines like Benadryl. In more severe cases, your doctor may prescribe:

  • Astringents – topical medicines that cleanse the skin and help prevent infection.
  • Corticosteroid creams and ointments – powerful anti-inflammatory medicines that provide short-term relief from redness and itching.
  • Antibiotics – used to treat bacterial skin infections. Your doctor may also recommend a longer course of therapy in order to reduce overall bacteria levels on your skin.
  • Oral antihistamines – help to relieve itching. They also cause drowsiness, which can be helpful if you're having trouble sleeping.
  • Oral/injected corticosteroids – like the topical forms, these drugs are very effective at reducing swelling and itching. Because long-term use can cause potentially serious side effects like high blood pressure and osteoporosis, they're usually only used for short periods to treat severe discomfort.
  • Immunomodulators – decrease the amount of inflammatory chemicals released by the immune system. Because of the potential for side effects, they're only used in severe cases when other treatments don't work.

Some people find that exposing the skin to natural sunlight or ultraviolet lamp light helps their AD rash. Unfortunately, ultraviolet radiation also carries serious health risks, including drying and aging of the skin and increased risk for skin cancer. Your doctor can help you decide if light therapy is right for you, and if so, what precautions to take.

Another thing you can do to help manage your AD is to avoid triggers when possible. Try to avoid getting overheated, manage stress, wear loose clothing and choose skin products designed for sensitive skin or labeled "hypoallergenic."

The good news about AD is that it tends to improve with age and often disappears by the teenage or young adult years. However, about half of all kids with AD continue to have flares into adulthood.

People who had AD as a child have a lifelong tendency toward dry skin and remain more susceptible to skin problems like staph and herpes virus infections. They may also be at increased risk for eye problems like cataracts.

Prevention

Because atopic dermatitis is probably a genetic condition, there's no way to prevent it. However, if you do have AD, take these steps to help prevent flares and complications:

  • Establish a skin care routine. Regularly apply a moisturizer with an ointment base (like petrolatum) to help relieve skin dryness and prevent cracking.
  • When bathing, use warm water and mild soap and scrub the skin gently.
  • Know the signs of skin infection and seek treatment promptly if they appear.
  • Practice positive stress management. Time management, exercise, mind-body practices, and talking to a friend are all positive ways to deal with emotions. A good counselor or psychologist can also help.
  • Find ways to decrease scratching. Some people scratch less when their hands are busy with an activity or when they surround themselves with others.
  • Use makeup and sunscreen designed especially for people with sensitive skin.

Sources

  • "Atopic Dermatitis." American Academy of Dermatology, 2014. http://www.aad.org/dermatology-a-to-z/diseases-and-treatments/a---d/atopic-dermatitis. Accessed July 10, 2014.
  • "Atopic Dermatitis." National Eczema Association, 2014. http://nationaleczema.org/eczema/types-of-eczema/atopic-dermatitis-2/. Accessed July 9, 2014.
  • "Atopic Dermatitis (Eczema)." Mayo Foundation for Medical Education and Research, 2011. http://www.mayoclinic.org/diseases-conditions/eczema/basics/definition/con-20032073. Accessed July 10, 2014.
  • "Eczema." National Eczema Association, 2014. http://nationaleczema.org/eczema. Accessed July 7, 2014.
  • "Eczema." The Nemours Foundation, 2012. http://kidshealth.org/parent/infections/skin/eczema_atopic_dermatitis.html#. Accessed July 10, 2014.