Atopic dermatitis

Infantile eczema; Dermatitis - atopic; Eczema

Last reviewed: November 21, 2011.
Atopic dermatitis is a long-term (chronic) skin disorder that involves scaly and itchy rashes.
See also:
Contact dermatitis
Dyshidrotic eczema
Nummular eczema
Seborrheic dermatitis
Causes, incidence, and risk factors
Atopic dermatitis is due to a hypersensitivity reaction (similar to an allergy) in the skin, which leads to long-term
swelling and redness (inflammation) of the skin. People with atopic dermititis may lack certain proteins in the skin,
which leads to greater sensitivity.
Atopic dermatitis is most common in infants. It may start as early as age 2 to 6 months. Many people outgrow it by
early adulthood.
People with atopic dermatitis often have asthma or seasonal allergies. There is often a family history of allergic
conditions such as asthma, hay fever, or eczema. People with atopic dermatitis often test positive to allergy skin
tests.
However, atopic dermatitis is not caused by allergies. The condition tends to get worse when the person is exposed
to certain triggers.
The following can make atopic dermatitis symptoms worse:
Allergies to pollen, mold, dust mites, or animals
Cold and dry air in the winter
Colds or the flu
Contact with irritants and chemicals
Contact with rough materials, such as wool
Dry skin
Emotions and stress
Exposure to too much water, such as taking too many baths or showers and swimming too often
Feeling too hot or too cold, as well as sudden temperature changes
Fragrances or dyes added to skin lotions or soaps
Symptoms
Typical skin changes may include:
Blisters with oozing and crusting
Dry skin all over the body or areas of bumpy skin on the back of the arms and front of the thighs
Ear discharge or bleeding
Raw areas of the skin from scratching
Skin coloring changes -- more or less color than the normal skin tone (See: Skin abnormally dark or
light)
Skin redness or inflammation around the blisters
Thickened or leather-like areas, called lichenification, which can occur after long-term irritation and
scratching
Both the type of rash and where the rash appears can depend on the age of the patient:
In children younger than age 2, skin lesions begin on the face, scalp, hands, and feet. They are often
crusting, bubbling, or oozing rashes that itch.
In older children and adults, the rash is more commonly seen on the inside of the knees and elbows, as
well as the neck, hands, and feet.
During a severe outbreak, rashes may occur anywhere on the body.
Itching, which is sometimes intense, almost always occurs. Itching may start even before the rash appears. Atopic
dermatitis is often called the "itch that rashes" because the itching starts, and then the skin rash appears from the
scratching.
Signs and tests
A physical exam will be done. A skin biopsy can be done to confirm the diagnosis or rule out other causes of dry,
itchy skin.
Diagnosis is based on the:
Appearance of the skin
Personal and family history
Allergy skin testing may be helpful for people with:
Hard-to-treat atopic dermatitis
Other allergy symptoms
Skin rashes that form only on certain areas of the body after exposure to a specific chemical
Treatment
SKIN CARE AT HOME
Taking care of your skin at home may reduce the need for medications.
Avoid scratching the rash or skin:
Relieve the itch by using a moisturizer, topical steroid cream, or other prescribed cream and taking
antihistamines to reduce severe itching.
Keep your child's fingernails cut short. Consider light gloves if nighttime scratching is a problem.
Keep the skin moist (called lubricating or moisturizing the skin). Use ointments (such as petroleum jelly), creams, or
lotions 2 - 3 times a day. Moisturizers should be free of alcohol, scents, dyes, fragrances, or other chemicals. A
humidifier in the home will also help.
Avoid anything that makes your symptoms worse. This may include:
Foods such as eggs in a very young child (always discuss with your doctor first)
Irritants such as wool and lanolin
Strong soaps or detergents, as well as chemicals and solvents
Sudden changes in body temperature and stress, which may cause sweating and worsen the condition
Triggers that cause allergy symptoms
When washing or bathing:
Keep water contact as brief as possible and use gentle body washes and cleansers instead of regular
soaps. Short, cooler baths are better then long, hot baths.
Do not scrub or dry the skin too hard or for too long.
After bathing, it is important to apply lubricating creams, lotions, or ointment on the skin while it is
damp. This will help trap moisture in the skin.
MEDICATIONS
At this time, allergy shots are not used to treat atopic dermatitis, although there is evidence that they may benefit
certain adults with atopic dermatitis.
Antihistamines taken by mouth may help with itching or if you have allergies. Often you can buy them without a
prescription.
Some antihistamines can cause sleepiness, but they may help with scratching while sleeping.
Newer antihistamines cause little or no sleepiness. Some are available over the counter. These
medications includefexofenadine (Allegra), loratadine (Claritin, Alavert), and cetirizine (Zyrtec).
Most causes of atopic dermatitis are treated with medications that are placed directly on the skin or scalp (called
topical medicines):
At first, you will probably be prescribed a mild cortisone (or steroid) cream or ointment. If this doesn't
work, you may need a stronger steroid medicine. You may need different strengths of steroids for
different areas of skin.
Medicines called topical immunomodulators (TIMs) may be prescribed for anyone over 2 years old.
TIMs include tacrolimus(protopic) and pimecrolimus (Elidel). Ask your doctor about concerns over a
possible cancer risk with the use of these medicines.
Creams or ointments that contain coal tar or anthralin may be used for thickened areas.
Barrier repair creams containing ceramides
Wet-wrap treatment with topical corticosteroids has been shown effective for atopic dermatitis, although it can have
side effects such as infection.
Other treatments that may be used include:
Antibiotic creams or pills if the skin is infected
Drugs that suppress the immune system, such as cyclosporine, methotrexate, or mycophenolate mofetil
Phototherapy, a medical treatment in which your skin is carefully exposed to ultraviolet (UV) light
Expectations (prognosis)
Atopic dermatitis is a long-term condition, but you can control it with treatment, by avoiding irritants, and by
keeping the skin well-moisturized.
In children, the condition often clears beginning at around age 5 - 6, but flare-ups will often occur. In adults, it is
generally a long-term or returning condition.
Atopic dermatitis may be harder to control if it:
Began at an early age
Involves a large amount of the body
Occurs along with allergic rhinitis and asthma
Occurs in someone with a family history of eczema
Complications
Infections of the skin caused by bacteria, fungi, or viruses
Permanent scars
Calling your health care provider
Call for an appointment with your health care provider if:
Atopic dermatitis does not respond to moisturizers or avoiding allergens
Symptoms get worse or treatment does not work
You have signs of infection (such as fever, redness, or pain)
Prevention
Studies have shown that children who are breast-fed until age 4 months are less likely to get atopic dermatitis.
If the child is not breast-fed, using a formula that contains processed cow milk protein (called partially hydrolyzed
formula) may decrease the chances of developing atopic dermatitis.