What is atopic dermatitis or eczema?
Atopic dermatitis, commonly referred to as eczema, is a hereditary skin disorder characterized by inflammation, such as a rash, that causes extreme itching and discomfort. Flare-ups of eczema, called exacerbations, lead the affected person to scratch which can cause broken skin, swelling, redness and what is called “weeping” of clear fluid from the affected area.
The term “atopic” refers to a group of diseases that are usually inherited such as asthma, hay fever, or food allergies. So, if there is anyone in the family such as a parent or grandparent who suffers from one or more of these disorders, you or your child’s likelihood of developing atopic dermatitis is much higher.
Types of Eczema (Dermatitis)
- Allergic contact eczema (dermatitis): a red, itchy, weepy reaction where the skin has come into contact with a substance that the immune system recognizes as foreign, such as poison ivy or certain preservatives in creams and lotions
- Atopic dermatitis: a chronic skin disease characterized by itchy, inflamed skin
- Contact eczema: a localized reaction that includes redness, itching, and burning where the skin has come into contact with an allergen (an allergy causing substance) or with an irritant such as an acid, a cleaning agent, or other chemical
- Dyshidrotic eczema: irritation of the skin on the palms of hands and soles of the feet characterized by clear, deep blisters that itch and burn
- Neurodermatitis: scaly patches of the skin on the head, lower legs, wrists, or forearms caused by a localized itch (such as an insect bite) that become intensely irritated when scratched
- Nummular eczema: coin-shaped patches of irritated skin (most common on the arms, back, buttocks, and lower legs) that may be crusted, scaling, and extremely itchy
- Seborrheic eczema: yellowish, oily, scaly patches of skin on the scalp, face, and occasionally other parts of the body
- Stasis dermatitis: a skin irritation on the lower legs, generally related to circulatory problems
What causes eczema?
Atopic dermatitis or eczema is closely associated with a malfunction of the body’s immune system. Doctors have recently discovered that among individuals that suffer from atopic dermatitis/eczema there is commonly found an increased amount of a certain cytokine (protein) that is essential to the normal function of the immune system and an increased amount of cytokines that induce allergic reactions. Essentially, the immune system is fooled into attacking the skin and causing inflammation even when an infection is not present.
At one point physicians believed that eczema was an emotional disorder. Now doctors are more informed and realize that although the exact cause, other than genetic heredity, is unknown, eczema or atopic dermatitis is a medical disorder. Changes in a person’s life that cause stress such as changes in employment, divorce, loss of a loved one, moving, sudden unrelated illness, etc., can definitely exacerbate the condition but are not the cause of the disorder.
Skin Features of Atopic Dermatitis
- Atopic pleat (Dennie-Morgan fold): an extra fold of skin that develops under the eye
- Cheilitis: inflammation of the skin on and around the lips
- Hyperlinear palms: increased number of skin creases on the palms
- Hyperpigmented eyelids: eyelids that have become darker in color from inflammation or hay fever
- Ichthyosis: dry, rectangular scales on the skin
- Keratosis pilaris: small, rough bumps, generally on the face, upper arms, and thighs
- Lichenification: thick, leathery skin resulting from constant scratching and rubbing
- Papules: small raised bumps that may open when scratched and become crusty and infected
- Urticaria: hives (red, raised bumps) that may occur after exposure to an allergen, at the beginning of flares, or after exercise or a hot bath
How is eczema diagnosed?
Diagnosis is mainly visual and may take several visits to your physician to determine if atopic dermatitis/eczema is actually the problem. Typically the patient will exhibit extremely dry, itchy skin with inflamed patches usually behind the knees, on the inner fold of the elbow, or on the face. The more the patient scratches the area in response to itching, the worse the appearance of the affected area will be – especially if affected by secondary infections. Your primary care physician may refer you to a dermatologist (skin specialist) or an allergist for further observation and testing. Most eczema patients are affected from infancy, but it may seem to improve by 18 months.
Typical Progression of Atopic Dermatitis/Eczema
|6-12 weeks||Patchy facial rash which can progress to red, scaling, oozing skin; May become infected|
|Crawling stage||Exposed areas like inner and outer parts of arms and legs may be affected|
|18 months||Condition may seem to improve but there is an increased risk of developing extremely dry skin or hand eczema later on|
|Early Childhood – Preteen||Papules form that become hard and scaly when scratched on areas behind the knees and crooks of the elbows; around the mouth, on wrists, ankles and hands. Licking of inflamed lips makes the condition worse leading to cracking and possibly infection. May go into remission only to return at the onset of puberty.|
Some patients may develop eczema later in life between their 30s and 60s but most cases start in early childhood.
Major and Minor Features of Atopic Dermatitis
- Major Features:
- Intense itching
- Characteristic rash in locations typical of the disease
- Chronic or repeatedly occurring symptoms
- Personal or family history of atopic disorders (eczema, hay fever, asthma)
- Some Minor Features:
- Early age of onset
- Dry skin that may also have patchy scales or rough bumps
- High levels of immunoglobulin E (IgE), an antibody, in the blood
- Numerous skin creases on the palms
- Hand or foot involvement
- Inflammation around the lips
- Nipple eczema
- Susceptibility to skin infection
- Positive allergy skin tests
- Skin Care: Atopic dermatitis treatments start with personal regimens that help to prevent moisture loss from the skin. Since the skin of a person affected by eczema is prone to water loss it is best to use emollients that create a protective barrier from the drying effects of the air and sun. It is also advisable to use non-soap cleansers when bathing to prevent further drying of the skin. When bathing do not take very long or very hot baths as this may dry and irritate the skin. Also patting the skin dry instead of rubbing is the best way to remove any excess moisture. Apply an appropriate emollient directly after bathing to help seal in the skin’s moisture. Always test lotions or creams on small areas to determine how your skin will react to their use.
- Phototherapy: Use of ultraviolet A or B light waves, alone or combined, can be an effective treatment for mild to moderate dermatitis in older children (over 12 years old) and adults. A combination of ultraviolet light therapy and a drug called psoralen can also be used in cases that are resistant to ultraviolet light alone. Possible long-term side effects of this treatment include premature skin aging and skin cancer. If the doctor thinks that phototherapy may be useful to treat the symptoms of atopic dermatitis, he or she will use the minimum exposure necessary and monitor the skin carefully.4
- Broad Band UVB
- Combination UVA and Broad Band UVB
- Narrow Band UVB
- Systemic Psoralen plus UVA
- Hydrosound bath in addition to phototherapy treatment
- Give lukewarm baths.
- Apply lubricant immediately following the bath.
- Keep child’s fingernails filed short.
- Select soft cotton fabrics when choosing clothing.
- Consider using sedating antihistamines to promote sleep and reduce scratching at night.
- Keep the child cool; avoid situations where overheating occurs.
- Learn to recognize skin infections and seek treatment promptly.
- Attempt to distract the child with activities to keep him or her from scratching.
- Identify and remove irritants and allergens.
What factors may make my atopic dermatitis/eczema worse?
Since atopic dermatitis is believed to be an immune disorder closely linked to other allergies, patients should themselves take close note of what affects them adversely and avoid those things. There are two groups of substances that patients need to take note of when determining what causes their skin condition to flare: irritants and allergens.
Irritants are substances that come in direct contact with the skin for a long enough period of time to cause inflammation. Items such as wool, synthetic fabrics, or poorly fitting clothing can cause rubbing and thus lead to inflammation. Also included in this list are items such as detergents, soaps that may cause drying, lotions with high amounts of water or alcohol, cosmetics, perfumes, solvents, dust, sand or cigarette smoke. Since there is such a wide variety of irritants and each person reacts differently to each one, each person is best suited to determine which items cause the disease to flare.
Allergens are substances from organic sources such as food, plants, animals or the air which cause the immune system to overreact to their presence. Inflammation can occur even if exposure is for a limited time and in small amounts. The air can carry such allergens as animal dander, pollens, dust mites, mold. It is undetermined whether inhalation of these items incites the inflammation or if only direct contact and penetration to the skin causes the problems.
Even food allergies can trigger or worsen a flare of atopic dermatitis. The most common allergy-causing foods are milk, soy, wheat, peanuts, fish and eggs. A food allergy can manifest itself in a number of ways such as skin inflammation, nausea and vomiting, abdominal pain, diarrhea, difficulty breathing, congestion or sneezing. It is best to consult with a physician before going on a strict diet, especially for young children since there are also nutritional factors that affect their growth and development that need to be considered.
Is there a cure for eczema?
Unfortunately, there is no eczema cure as this is an immune related chronic disease. There are many treatments available for atopic dermatitis/eczema that can help keep the disease in remission, but scientists are still trying to find what genetic path is being passed on that causes the disease.
What are the available eczema treatments?
There are many sources of information available on the internet and from your physician about eczema treatment and we encourage you to do your research. Here we are providing just a sampling of the eczema treatments that offer you less risk as a patient. Please consult your dermatologist and/or allergist to find a treatment regimen that is right for you.
Depending on the severity of the affectation your dermatologist may prescribe protocols involving:
The Daavlin Company is a manufacturer of phototherapy equipment in UVA, Narrow Band UVB, and Broad Band UVB and combinations of these. Information is available for patients looking to acquire a unit for home use and also for dermatologists seeking to buy for their clinic environment.
Treating Atopic Dermatitis in Infants and Children
Is there anything I can do to help myself?
As was mentioned previously, as the affected person or caregiver of the affected patient, it is best to be very observant of irritants or allergens that cause inflammation. Also, lifestyle changes may help eliminate or lessen symptoms. If your career involves constant contact with irritants or excessive hand washing it may be in your best interest to seek out another career path that will suit you and your health.
When faced with stressful situations that can make the inflammation worse, use communication as your tool of choice. Talk to family and friends about your distress or even seek counseling to help you better handle the situation. A source of stress that hasn’t been discussed is the perception of the disease by others. In this case communication is also your best tool. Let your family know what is happening to your body, what affects you and that it is not contagious. In this way you form a support net that understands and is more likely to help when life gets tough.
Where can I find out more about eczema and available treatments?
National Institute of Arthritis and Musculoskeletal and Skin Diseases
NIAMS/National Institutes of Health
1 AMS Circle
Bethesda, MD 20892-3675
American Academy of Dermatology
P.O. Box 4014
Shaumburg, IL 60168-4014
Phone: 847-330-0230 or 888-462-DERM (3376) (free of charge)
National Eczema Society
London, N19 5NA
Office Tel: 020 7281 3553
Fax 020 7281 6395
A service of the U.S. National Library of Medicine
and the National Institutes of Health
U.S. National Library of Medicine
8600 Rockville Pike
Bethesda, MD 20894
Toll Free: (888) FIND-NLM (888) 346-3656
Phone: (301) 594-5983 (local and international calls)
Fax: (301) 402-1384
ILL Fax: (301) 496-2809
“Eczema: Frequently Asked Questions.” National Eczema Society, 2005. http://www.eczema.org/faqfile.htm
1, 2, 3, 4, 5Handout on Health: Atopic Dermatitis. National Institute of Arthritis and Musculoskeletal and Skin Diseases and National Institute of Health, January 1999, rev. April 2003. http://www.niamhs.nih.gov/hi/topics/dermatitis