Atopic dermatitis (eczema)
Definition :
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Atopic dermatitis (eczema) is an itchy inflammation of your skin. It's a long-lasting (chronic) condition that may be accompanied by asthma or hay fever.
Eczema may affect any area of your skin, but it typically appears on your arms and behind your knees. It tends to flare periodically and then subside. The cause of atopic dermatitis is unknown, but it may result from a combination of inherited tendencies for sensitive skin and malfunction in the body's immune system.
Self-care measures, such as avoiding soaps or other irritants and applying creams or ointments, can help relieve itching. See your doctor if your symptoms distract you from your daily routines or prevent you from sleeping.
Symptoms:
Signs and symptoms of atopic dermatitis (eczema) include:
Atopic dermatitis most often begins in childhood before age 5 and may persist into adulthood. For some, it flares periodically and then subsides for a time, even up to several years. Itching may be severe, and scratching the rash can make it even itchier and cause more inflammation. Once the skin barrier is broken, the skin can become infected by bacteria, especially Staphylococcus aureus, which commonly live on the skin. Breaking this itch-scratch cycle can be challenging.
Factors that worsen atopic dermatitis
Most people with atopic dermatitis also have Staphylococcus aureus bacteria on their skin. The staph bacteria multiply rapidly when the skin barrier is broken and fluid is present on the skin, which in turn may worsen symptoms, particularly in young children.
Other factors that can worsen signs and symptoms of atopic dermatitis include:
When atopic dermatitis occurs in infants, it's called infantile eczema. This condition may continue into childhood and adolescence.
Infantile eczema often involves an oozing, crusting rash, mainly on the skin of the face and scalp, but it can occur anywhere. After infancy, the rash becomes dryer and tends to be red to brown-gray in color. In adolescence, the skin may be scaly or thickened and easily irritated. The intense itching may continue.
When to see a doctor
See your doctor if:
Early, effective treatment helps keep atopic dermatitis from worsening. The more severe it becomes, the more difficult it is to control.
Causes:
The exact cause of atopic dermatitis (eczema) is unknown, but it's likely due to a combination of dry, irritable skin with a malfunction in the body's immune system. Stress and other emotional disorders can worsen atopic dermatitis, but they don't cause it.
Most experts believe atopic dermatitis has a genetic basis. It has been thought to be connected to asthma and hay fever, but that theory is being questioned. Not all people with atopic dermatitis have asthma or hay fever, and not all people with asthma or hay fever develop atopic dermatitis, but these diseases do seem to be present together in families of those affected.
Complications:
Complications of atopic dermatitis (eczema) include:
Treatments and drugs:
Treatments for atopic dermatitis (eczema) aim to reduce inflammation, relieve itching and prevent future flare-ups. Over-the-counter (nonprescription) anti-itch creams and other self-care measures may help control mild atopic dermatitis.
Although atopic dermatitis is related to allergies, eliminating allergens is rarely helpful in clearing the condition. Occasionally, items that trap dust — such as feather pillows, down comforters, mattresses, carpeting and drapes — can worsen the condition. Allergy shots usually aren't successful in treating atopic dermatitis.
Medications
As the name suggests, this treatment uses natural or artificial light. The simplest and easiest form of phototherapy involves exposing your skin to controlled amounts of natural sunlight. Other forms of light therapy include the use of artificial ultraviolet A (UVA) or ultraviolet B (UVB) light including the more recently available narrow band ultraviolet B (NBUVB) either alone or with medications.
Though effective, long-term light therapy has many harmful effects, including premature skin aging and an increased risk of skin cancer. For these reasons, it's important to consult your doctor before using light exposure as treatment for atopic dermatitis. Your doctor can advise you of possible advantages and disadvantages of light exposure in your specific situation.
Infantile eczema
Treatment for infantile eczema includes identifying and avoiding skin irritations, avoiding extreme temperatures, and lubricating your baby’s skin with bath oils, lotions, 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 his or her symptoms or to treat the infection. Your doctor may recommend an oral antihistamine to help lessen the itch and to cause drowsiness, which may be helpful for nighttime itching and discomfort.
Definition :
Atopic dermatitis (eczema) is an itchy inflammation of your skin. It's a long-lasting (chronic) condition that may be accompanied by asthma or hay fever.
Eczema may affect any area of your skin, but it typically appears on your arms and behind your knees. It tends to flare periodically and then subside. The cause of atopic dermatitis is unknown, but it may result from a combination of inherited tendencies for sensitive skin and malfunction in the body's immune system.
Self-care measures, such as avoiding soaps or other irritants and applying creams or ointments, can help relieve itching. See your doctor if your symptoms distract you from your daily routines or prevent you from sleeping.
Symptoms:
Signs and symptoms of atopic dermatitis (eczema) include:
- Red to brownish-gray colored patches
- Itching, which may be severe, especially at night
- Small, raised bumps, which may leak fluid and crust over when scratched
- Thickened, cracked or scaly skin
- Raw, sensitive skin from scratching
Atopic dermatitis most often begins in childhood before age 5 and may persist into adulthood. For some, it flares periodically and then subsides for a time, even up to several years. Itching may be severe, and scratching the rash can make it even itchier and cause more inflammation. Once the skin barrier is broken, the skin can become infected by bacteria, especially Staphylococcus aureus, which commonly live on the skin. Breaking this itch-scratch cycle can be challenging.
Factors that worsen atopic dermatitis
Most people with atopic dermatitis also have Staphylococcus aureus bacteria on their skin. The staph bacteria multiply rapidly when the skin barrier is broken and fluid is present on the skin, which in turn may worsen symptoms, particularly in young children.
Other factors that can worsen signs and symptoms of atopic dermatitis include:
- Dry skin
- Long, hot baths or showers
- Stress
- Sweating
- Rapid changes in temperature
- Low humidity
- Solvents, cleaners, soaps or detergents
- Wool or man-made fabrics or clothing
- Dust or sand
- Cigarette smoke
- Living in cities where pollution is high
- Certain foods, such as eggs, milk, fish, soy or wheat
When atopic dermatitis occurs in infants, it's called infantile eczema. This condition may continue into childhood and adolescence.
Infantile eczema often involves an oozing, crusting rash, mainly on the skin of the face and scalp, but it can occur anywhere. After infancy, the rash becomes dryer and tends to be red to brown-gray in color. In adolescence, the skin may be scaly or thickened and easily irritated. The intense itching may continue.
When to see a doctor
See your doctor if:
- You're so uncomfortable that you're losing sleep or are distracted from your daily routines
- Your skin is painful
- You suspect your skin is infected
- You've tried self-care steps without success
Early, effective treatment helps keep atopic dermatitis from worsening. The more severe it becomes, the more difficult it is to control.
Causes:
The exact cause of atopic dermatitis (eczema) is unknown, but it's likely due to a combination of dry, irritable skin with a malfunction in the body's immune system. Stress and other emotional disorders can worsen atopic dermatitis, but they don't cause it.
Most experts believe atopic dermatitis has a genetic basis. It has been thought to be connected to asthma and hay fever, but that theory is being questioned. Not all people with atopic dermatitis have asthma or hay fever, and not all people with asthma or hay fever develop atopic dermatitis, but these diseases do seem to be present together in families of those affected.
Complications:
Complications of atopic dermatitis (eczema) include:
- Neurodermatitis. Prolonged itching and scratching
may increase the intensity of the itch, possibly leading to
neurodermatitis (lichen simplex chronicus). Neurodermatitis is a
condition in which an area of skin that's frequently scratched becomes
thick and leathery. The patches can be raw, red or darker than the rest
of your skin. Persistent scratching can also lead to permanent scars or
changes in skin color.
- Skin infections. Sometimes, scratching can break
the skin and cause open sores and fissures that can become infected, a
process called impetiginization. A milder form of infection is impetigo,
usually due to staphylococcal infection. Having atopic dermatitis
predisposes you to this infection.
- Eye complications. Severe atopic dermatitis can also cause eye complications, which may lead to permanent eye damage. When these complications occur, itching in and around the eyelids becomes severe. Signs and symptoms of eye complications also include eye watering and inflammation of the eyelid (blepharitis) and the lining of the eyelid (conjunctivitis). If you suspect complications with your eyes, see your doctor promptly.
Treatments and drugs:
Treatments for atopic dermatitis (eczema) aim to reduce inflammation, relieve itching and prevent future flare-ups. Over-the-counter (nonprescription) anti-itch creams and other self-care measures may help control mild atopic dermatitis.
Although atopic dermatitis is related to allergies, eliminating allergens is rarely helpful in clearing the condition. Occasionally, items that trap dust — such as feather pillows, down comforters, mattresses, carpeting and drapes — can worsen the condition. Allergy shots usually aren't successful in treating atopic dermatitis.
Medications
- Corticosteroid creams or ointments. Your doctor may
recommend prescription corticosteroid creams or ointments to ease
scaling and relieve itching. Some low-potency corticosteroid creams are
available without a prescription, but you should always talk to your
doctor before using any topical corticosteroid. Side effects of
long-term or repeated use can include skin irritation or discoloration,
thinning of the skin, infections, and stretch marks on the skin.
- Antibiotics. You may need antibiotics if you have a
bacterial skin infection or an open sore or fissure caused by
scratching. Your doctor may recommend taking antibiotics for a short
time to treat an infection or for longer periods of time to reduce
bacteria on your skin and to prevent recurrent infections.
- Oral antihistamines. If itching is severe, oral
antihistamines may help. Diphenhydramine (Benadryl, others) can make you
sleepy and may be helpful at bedtime. If your skin cracks open, your
doctor may prescribe mildly astringent wet dressings to prevent
infection.
- Oral or injected corticosteroids. For more severe
cases, your doctor may prescribe oral corticosteroids, such as
prednisone, or an intramuscular injection of corticosteroids to reduce
inflammation and to control symptoms. These medications are effective,
but can't be used long term because of potential serious side effects,
which include cataracts, loss of bone mineral (osteoporosis), muscle
weakness, decreased resistance to infection, high blood pressure and
thinning of the skin.
- Immunomodulators. A class of medications called immunomodulators, such as tacrolimus (Protopic) and pimecrolimus (Elidel), affect the immune system and may help maintain normal skin texture and reduce flares of atopic dermatitis. This prescription-only medication is approved for children older than 2 and for adults. Due to possible concerns about the effect of these medications on the immune system when used for prolonged periods, the Food and Drug Administration recommends that Elidel and Protopic be used only when other treatments have failed or if someone can't tolerate other treatments.
As the name suggests, this treatment uses natural or artificial light. The simplest and easiest form of phototherapy involves exposing your skin to controlled amounts of natural sunlight. Other forms of light therapy include the use of artificial ultraviolet A (UVA) or ultraviolet B (UVB) light including the more recently available narrow band ultraviolet B (NBUVB) either alone or with medications.
Though effective, long-term light therapy has many harmful effects, including premature skin aging and an increased risk of skin cancer. For these reasons, it's important to consult your doctor before using light exposure as treatment for atopic dermatitis. Your doctor can advise you of possible advantages and disadvantages of light exposure in your specific situation.
Infantile eczema
Treatment for infantile eczema includes identifying and avoiding skin irritations, avoiding extreme temperatures, and lubricating your baby’s skin with bath oils, lotions, 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 his or her symptoms or to treat the infection. Your doctor may recommend an oral antihistamine to help lessen the itch and to cause drowsiness, which may be helpful for nighttime itching and discomfort.
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