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Atopic Dermatitis/Eczema

Eczema and dermatitis are used to describe certain types of inflamed skin conditions including nummular dermatitis and allergic contact dermatitis.  Common symptoms associated with Eczema included skin that normally itches, is red, oozing, blistered, scaly, and in some cases is brownish in color.  A common form is called atopic eczema or atopic dermatitis.

Atopic Eczema Or Atopic Dermatitis
The term "atopic" refers to a tendency for excess inflammation in the skin and the linings of the nose and lungs.  This condition is often found in families who also suffer allergies, sensitive skin, asthma, or a history of atopic dermatitis.  The majority of patients who suffer from atopic dermatitis have other family members with a similar condition; in about 20 percent of the cases the person is the only person in the family who has the condition.
Atopic dermatitis is a common condition worldwide.  In   North America it affects approximately 10 percent of infants and 3 percent of the entire population.
Although it can affect people of any age it is most common in infants and young adults.  The skin rash is very itchy and can be widespread, or limited to a few areas.
The condition often improves with adolescence, although many patients are affected by it their entire life.  An adult who is affected by atopic eczema normally does not suffer from as severe of symptoms as they did when they were a child.

Infantile Eczema
When an infant develops the condition, it is referred to as infantile eczema.  The infant may experience an itchy rash that can also be crusting, or oozing.  It is normally found on the face or scalp, but patches can appear anywhere.  Because of the itch, children may rub their head, cheeks, and other patches with a hand, a pillow, or anything within reach.  The condition can cause nighttime restlessness, crying, & irritability.  In about 50 percent of the cases by the time a child is two years old the Infantile Eczema will resolve.  In cases involving children under the age of one year there has been an association with milk allergy.  Although, a change to Soy milk protein is only recommended in severe cases.  There is no proof associating food allergies with dermatitis in children older than one year.

Eczema In Later Life
In older children, teens and young adults, the patches normally occur on the hands and feet.  Although, areas that flex such as the elbows, wrists, backs of the knees, ankles, neck, face, and even the upper chest can be affected.  When it is found on the fingers, backs of the hands, palms or on the soles of the feet, crusting and oozing are common.
Other patches of eczema in this stage usually range from red to brownish-gray in color, are dry, and can be thick or scaly.  Without treatment the thickened areas of skin can last for years.  The intense, virtually unbearable itching sensation can continue most patients find it most noticeable during the night.  Some patients scratch the skin until it bleeds and crusts.  When this happens, there is a significant risk of infection.
A small percentage of patients will continue to have eczema throughout their lives into adulthood, sometimes it may manifest simply as sensitive skin.  Adults with a past history of eczema may get eczema on their hands in their later years.  Occasionally adults with a family history of eczema who did not have eczema as a child will get hand eczema as an adult.

Frequently asked questions about Atopic Dermatitis/Eczema

Q.  Can skin tests, such those for asthma and hay fever, be helpful in determining the cause?
A.  Not usually.  A positive test means allergy only about 20% of the time.  If negative, the test is good evidence against allergy.

Q.  Are "shots" such as those given for hay fever and other allergies, useful?
A.  Not usually.  They may even make the skin condition worse in some patients. 

Q.  What is the importance of environmental causes, should they be eliminated?
A.  Seldom does the elimination of contact and airborne substances result in lasting relief.  Occasionally, dust or dust-catching objects such as down comforters, mattresses, kapok pillows, feather pillows, carpeting, drapes, wool, some toys, and other rough fabrics, can aggravate atopic dermatitis.

Q.  Since this condition is associated with allergies, can certain foods be the cause?
A.  Rarely (perhaps 10%).  Although in some cases foods may aggravate atopic dermatitis, this is especially common in infants, and young children with asthma, eliminating those foods rarely cure the condition.  Any foods that result in immediate severe reactions or welts/hives should be eliminated.

Q.  How should this condition be treated?
A.  Proper management considerations include:
  • SOAPuse only unscented soaps and use them sparingly, such as Dove Unscented, Cetaphil bar or cleansers.
  • MOISTURIZEat least once daily, year-round, preferably immediately after bathing.  Cetaphil Cream, Cerave or Lipikar AP are good choices and are available over-the-counter.
  • Use a humidifier in the sleeping space (or whole house) especially through the winter.
  • 100% COTTON CLOTHING WHEN POSSIBLE.  Avoid wool and polyester blends.  In infants metal snaps from sleepers may cause eczema on the trunk due to an associated nickel allergy.
  • You can bathe daily if you moisturize after bath.  I do not recommend bath oil, they are unnecessary if you moisturize after bath.  Oils are also dangerous and add extra work to cleaning the bathroom.
  • SUNSCREENS: are often irritating with Atopic eczema.  Try Non-Chemical Sunscreens such as: MARCELLE NON-CHEMICAL SUNSCREEN, or AVENE SPF 50 NON-CHEMICAL SUNSCREEN available at most major drug stores.
  • Keep nails short
  • Rapid temperature changes, activities that cause sweating and significant stress/emotional upset can exacerbate the condition
  • Your dermatologist may prescribe:
  • Topical (“on the skin”) medications such as steroids or the newer non-steroid creams (e.g.  Tacrolimus, Pimecrolimus).  Ointments, while oilier are MUCH more effective than creams at controlling symptoms and improving the disease process quickly.
  • Oral medications such as antihistamines can soothe the itch when taken at night time.
  • Oral antibiotics may be prescribed if there is a secondary infection. 
  • UV Light therapy for resistant case
  • For severe cases, your dermatologist may recommend other treatments oral medications.

Atopic dermatitis is a very common condition.  While there is no cure, with proper treatment, the disease can be controlled in the majority of people.

More Information:
www.nationaleczema.org
www.eczemacanada.ca
www.skinpatientalliance.ca/

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