Atopic Dermatitis

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Atopic Dermatitis

Atopic dermatitis, or eczema, is the name given to a stubborn, itchy rash that occurs in certain people with sensitive or irritable skin.  These individuals often have a history of allergies, food or drug sensitivities, or asthma.  Eczema is common in infants and young children but often disappears or becomes less severe in adulthood.  Many patients with hand dermatitis had atopic dermatitis as children.

What Causes Atopic Dermatitis?

The cause of eczema is an abnormality in the immune system.  It appears to be genetic and to run in families.  Eczema is not contagious and is not related to your general health.  People with eczema have skin that is dry and easily irritated by soap, detergents and rough woolen clothing.  Very hot or very cold, dry weather often aggravates eczema.  Skin allergy testing is often performed but not often helpful since individuals with eczema often have other allergies.

Treatment

Since eczema is a result of an abnormality in the immune system and the skin, no permanent cure is possible.  Eczema can be controlled but it requires time spent caring for the skin every day.  Most individuals are able to live comfortably once they find a treatment regimen effective for their particular skin and climate.

Corticosteroid and lubricant compounds applied to the skin are the mainstay of eczema therapy.  These creams and ointments must be applied often and the exact preparations will require both you and your physician’s input.

Newer therapies are available. Protopic (tacrolimus) and Elidel (pimecrolimus) are in a non-steroid class of medications called immune modulators.  These medications work by turning off the particular parts of the immune system that activate eczema.  They are very safe, with very few side effects.

Careful use of ultraviolet light therapy can also be quite successful.  This is not a tanning bed, but a specific type of light given in small doses in the office.

Treatment Principles

Grease, grease, grease! Diligent use of moisturizing creams and lotions is the main treatment for eczema.  Frequent applications (4-8 times) throughout the day may be needed.  For infants, a moisturizer is recommended with each diaper change. The best moisturizers are the newer ones that contain ceramides.  CeraVe replaces lipids (fats in the skin) and repairs the damaged skin barrier.  Some other examples of good moisturizers include Aveeno, Aquaphor, Eucerin, Cetaphil, Keri, and Lubriderm.

Avoid dry skin! Skin is dry as a result of lack of water, not oil.  Soaking in a bathtub 10-15 minutes will rehydrate the skin but unless an oil or lubricant is applied immediately after bathing and gently patting excess water off the skin, evaporation will cause additional dryness.  Showers tend to be more drying than baths.

Soap irritates and dries the skin.  People with eczema should avoid it.  Use as little soap as possible.  Try soap-free cleansers with moisturizing qualities (CeraVe, Dove, Purpose, Basis, Neutrogena, Oil of Olay, and Aveeno).

Hot weather and heavy sweating often worsen eczema. Wear cool, loose clothing and try to stay in air-conditioned environments.

Avoid rough clothing, wool or friction against the skin.

Do not use fabric softeners or dryer sheets for anyone’s clothes.  In the laundry, use a hypoallergenic detergent.

Avoid any creams, makeup, perfumes or chemicals which seem to irritate the skin.

Once a treatment is successful, it can often be used safely for many years with only an occasional flare or intervention required by a physician.

If your eczema is worsening despite appropriate treatment efforts, please return to the office before your condition gets too far out of control.

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